Insertion instrument for anchor assembly

ABSTRACT

An insertion instrument is configured to eject a pair of anchor bodies across an anatomical gap so as to approximate the gap. The insertion instrument can include a single cannula that retains the pair of anchor bodies in a stacked relationship, or a pair of adjacent cannulas that each retain respective anchor bodies. The insertion instrument can be actuated so as to eject the anchor bodies into respective target anatomical locations.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 13/095,192, which claims the benefit of U.S. Patent ApplicationSer. No. 61/328,251 filed on Apr. 27, 2010 (Overes), the disclose oreach of which is hereby incorporated by reference as if set forth in itsentirety herein. This application claims the benefit of U.S. PatentApplication Ser. No. 61/398,699 filed on Jun. 29, 2010 (Overes, et al.),U.S. Patent Application Ser. No. 61/432,755 filed on Jan. 14, 2011(Henrichsen, et al.), U.S. Patent Application Ser. No. 61/461,490 filedon Jan. 18, 2011 (Henrichsen, et al.), and U.S. Patent Application Ser.No. 61/443,142 filed on Feb. 15, 2011 (Overes), the disclosure of eachof which is hereby incorporated by reference as if set forth in itsentirety herein.

BACKGROUND

Orthopaedic surgical procedures often involve the use of a fixationdevice. Usually an access hole is produced in a bone or soft tissuewherein a suitable fixation device can be fastened. Apart from screws,expandable fixations devices can be used which are inserted into thehole in a collapsed state and transformed into an expanded state oncebeing correctly positioned.

In one example orthopaedic surgical procedure, such as a lumbarmicrodiscectomy, radiculopathy is treated by surgically removing theherniated nucleus pulposus to achieve neural decompression. The lumbarmicrodiscectomy is one of the most common spinal surgeries performedtoday. Many patients find relief with this procedure, but for others,the disc could re-herniate through the opening in the annulus resultingin continuing pain and potentially requiring additional surgery.Currently, the standard microdiscectomy technique does not involveclosing the annular defect and presents the surgeon with a dilemma. Thesurgeon may elect to remove the herniated portion of the nucleusimpinging on the nerves, which treats radiculopathy, but may increasethe risk of post-operative reherniation of the remaining nucleus throughthe existing defect of the annulus. Alternately, the surgeon may electto perform extensive debulking, in which most of the remaining nucleusmaterial is removed in addition to the herniated portion to minimize therisk of post-operative reherniation. However, the risk of post-operativedisc height collapse and subsequent progression to lower back painincreases.

Conventional expandable implants include a sleeve with an expandableportion having plurality of fingers or expandable parts formed byintermediate slots or holes in the peripheral wall of the sleeve and acompression element extending through the central bore of the sleeve.The compression element can be coupled to the front end of the sleeve sothat upon pulling said compression element towards the rear end of thesleeve said fingers or expandable parts are bent radially outwards so asto transform said expandable portion from its collapsed state to itsexpanded state.

SUMMARY

In accordance with one embodiment, an insertion instrument is configuredto eject at least one anchor at a target location. The anchor includesan anchor body that has a substrate that extends substantially along adirection of elongation. The substrate defines a plurality of openingsspaced along the direction of elongation. The anchor further includes anactuation member that is woven through at least two of the openings. Theinsertion instrument includes a cannula that defines an elongate openingsized to receive the anchor body. The insertion instrument furtherincludes a pusher member insertable into the cannula and configured tobe depressed in the elongate opening so as to eject the anchor body fromthe cannula and into the target location. When a tensile force isapplied to the actuation member along a direction substantially alongthe direction of elongation, the anchor body collapses along thedirection of elongation and expands along a second perpendicular withrespect to the direction of elongation.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing summary, as well as the following detailed description ofan example embodiment of the application, will be better understood whenread in conjunction with the appended drawings, in which there is shownin the drawings example embodiments for the purposes of illustration. Itshould be understood, however, that the application is not limited tothe precise arrangements and instrumentalities shown. In the drawings:

FIG. 1A is a schematic side elevation view of an anchor assemblyincluding a pair of anchor bodies implanted across an anatomical defectand shown in a first configuration;

FIG. 1B is a schematic side elevation view of the anchor assemblyillustrated in FIG. 1A, showing the anchor bodies in an expandedconfiguration and in an approximated position;

FIG. 1C is a side elevation view of an anchor assembly including theanchor bodies illustrated in FIG. 1A and a connector member configuredto attach actuation portions of the anchor bodies, showing the anchorbodies in the first configuration;

FIG. 1D is a side elevation view of the anchor assembly illustrated inFIG. 1C, showing the connector member tightened with the anchor bodiesin the expanded configuration;

FIG. 1E is a side elevation view of an anchor assembly similar to FIG.1C, but including an integral connector member;

FIG. 1F is a side elevation view of the anchor assembly illustrated inFIG. 1E, showing the connector member tightened with the anchor bodiesin the expanded configuration;

FIG. 1G is a schematic side elevation view of an anchor assemblyincluding a pair of anchor bodies constructed in accordance with analternative embodiment, shown implanted across an anatomical defect andshown in a first configuration;

FIG. 1H is a schematic side elevation view of the anchor assemblyillustrated in FIG. 1G, showing the anchor bodies in an expandedconfiguration and in an approximated position;

FIG. 2A is a side elevation view of an anchor assembly including firstand second anchors implanted in an anatomical structure on opposed sidesof an anatomical defect and shown in a first configuration;

FIG. 2B is a side elevation view of the anchor assembly illustrated inFIG. 2A, showing the first and second anchors in respective expandedconfigurations;

FIG. 2C is a side elevation view of the anchor assembly illustrated inFIG. 2A, including a connector member that attaches the first anchor tothe second anchor;

FIG. 3A is a side elevation view of a fixation kit including at leastone anchor and an insertion instrument;

FIG. 3B is a sectional side elevation view of the fixation kitillustrated in FIG. 3A;

FIG. 4A is a sectional elevation view of a fixation kit constructed inaccordance with an alternative embodiment, shown in a first rotativestate;

FIG. 4B is a sectional side elevation view of the kit illustrated inFIG. 4A, taken along line 4B-4B;

FIG. 4C is a sectional side elevation view of the fixation kit asillustrated in FIG. 4A, but shown in a second rotative state whereby apair of apertures is aligned;

FIG. 4D-sectional side elevation view of the fixation kit illustrated inFIG. 4C, taken along line 4D-4D;

FIG. 5A is a sectional side elevation view of an insertion instrumentduring assembly;

FIG. 5B is a sectional side elevation view of the insertion instrumentillustrated in FIG. 5A, but shown assembled;

FIG. 5C is a sectional side elevation view of a handle of the insertioninstrument illustrated in FIG. 5B;

FIG. 5D is a perspective view of the handle illustrated in FIG. 5C;

FIG. 6 is a side elevation view of the fixation kit constructed inaccordance with another embodiment;

FIG. 7A is a perspective view of a fixation kit including an insertioninstrument constructed in accordance with an alternative embodimentincluding a casing and a cannula extending from the casing, theinstrument shown in a first configuration with first and second anchorbodies loaded in the insertion instrument;

FIG. 7B is an enlarged perspective view of the cannula of the insertioninstrument illustrated in FIG. 7A;

FIG. 7C is a sectional side elevation view of the casing of theinsertion instrument illustrated in FIG. 7A;

FIG. 7D is an enlarged sectional side elevation view of the cannula ofthe insertion instrument illustrated in FIG. 7A;

FIG. 8A is a perspective view of the fixation kit illustrated in FIG.7A, showing the insertion instrument in the second position so as toeject the second anchor body from the insertion instrument, the secondanchor body shown in a first configuration

FIG. 8B is an enlarged perspective view of the cannula of the insertioninstrument illustrated in FIG. 8A;

FIG. 8C is a sectional side elevation view of the casing illustrated inFIG. 8A;

FIG. 8D is a sectional side elevation view of the cannula illustrated inFIG. 8A;

FIG. 9A is a perspective view of the fixation kit illustrated in FIG.8A, showing the insertion instrument in an offset position;

FIG. 9B is an enlarged perspective view of the cannula of the insertioninstrument illustrated in FIG. 9A

FIG. 9C is a sectional side elevation view of the casing of theinsertion instrument illustrated in FIG. 9A;

FIG. 9D is a sectional side elevation view of the cannula of theinsertion instrument illustrated in FIG. 9A;

FIG. 9E is a perspective view of the fixation kit illustrated in FIG.9A, showing the second anchor body in an expanded configuration;

FIG. 10A is a perspective view of the fixation kit illustrated in FIG.9A, showing the insertion instrument in an intermediate position uponcompletion of an intermediate stroke;

FIG. 10B is an enlarged perspective view of the cannula of the insertioninstrument illustrated in FIG. 10A

FIG. 10C is a sectional side elevation view of the casing of theinsertion instrument illustrated in FIG. 10A;

FIG. 10D is a sectional side elevation view of the cannula of theinsertion instrument illustrated in FIG. 10A

FIG. 11A is a perspective view of the fixation kit illustrated in FIG.10A, showing the insertion instrument upon completion of a first portionof a second stroke after the intermediate stroke;

FIG. 11B is an enlarged perspective view of the cannula of the insertioninstrument illustrated in FIG. 11A

FIG. 11C is a sectional side elevation view of the casing of theinsertion instrument illustrated in FIG. 11A;

FIG. 11D is a sectional side elevation view of the cannula of theinsertion instrument illustrated in FIG. 11A;

FIG. 12A perspective view of the fixation kit illustrated in FIG. 11A,showing the insertion instrument in a third position upon completion ofa second portion of the second stroke, ejecting a first anchor body fromthe insertion instrument, the first anchor body shown in a firstconfiguration;

FIG. 12B is an enlarged perspective view of the cannula of the insertioninstrument illustrated in FIG. 12A;

FIG. 12C is a sectional side elevation view of the casing of theinsertion instrument illustrated in FIG. 12A;

FIG. 12D is a sectional side elevation view of the cannula of theinsertion instrument illustrated in FIG. 12A;

FIG. 12E is a perspective view of the fixation kit similar to FIG. 12A,but showing the first anchor body in an expanded configuration;

FIG. 12F is a sectional side elevation view of the casing of theinsertion instrument illustrated in FIG. 12A, after release of a strandretention mechanism;

FIG. 13A is a perspective view of the insertion instrument illustratedin FIG. 7A, with portions removed so as to illustrate a guide systemwhen the instrument is in the first position;

FIG. 13B is a perspective view of the insertion instrument illustratedin FIG. 8A, showing the guide system when the instrument is in thesecond position;

FIG. 13C is a perspective view of the insertion instrument illustratedin FIG. 9A, with portions removed so as to illustrate the guide systemwhen the insertion instrument is in the offset position;

FIG. 13D is a perspective view of the insertion instrument illustratedin FIG. 10A, with portions removed so as to illustrate the guide systemwhen the insertion instrument is in the intermediate position;

FIG. 13E is a perspective view of the insertion instrument illustratedin FIG. 11A, with portions removed so as to illustrate the guide systemwhen the insertion instrument has completed the first portion of thesecond stroke;

FIG. 13F is a perspective view of the insertion instrument illustratedin FIG. 12A, with portions removed so as to illustrate the guide systemwhen the insertion instrument has completed the second portion of thesecond stroke;

FIG. 13G is a perspective view of a guide track of the guide systemillustrated in FIG. 13A;

FIG. 14A is a perspective view of a coupling assembly constructed inaccordance with one embodiment,

FIG. 14B is a sectional side elevation view of the coupling assemblyillustrated in FIG. 14A, shown in a first mode of operation;

FIG. 14C is a sectional side elevation view of the coupling assemblyillustrated in FIG. 14B, shown in a transition between the first mode ofoperation and a second mode of operation;

FIG. 14D is a sectional side elevation view of the coupling assemblyillustrated in FIG. 14C, shown in the second mode of operation.

FIG. 15A is a sectional side elevation view of the insertion instrumentconstructed in accordance with another embodiment, showing a couplingassembly disposed in a first mode of operation;

FIG. 15B is a sectional end elevation view of the coupling assemblyillustrated in FIG. 15A, taken along line 15B-15B;

FIG. 15C is a sectional side elevation view of the insertion instrumentillustrated in FIG. 15A, but showing the coupling assembly transitioningfrom the first mode of operation to a second mode of operation;

FIG. 15D is a sectional end elevation view of the coupling assemblyillustrated in FIG. 15C, taken along line 15D-15D;

FIG. 15E is a sectional side elevation view of the insertion instrumentillustrated in FIG. 15C, but showing the coupling assembly in the secondmode of operation;

FIG. 16A is a schematic side elevation view of the anchor assembly asillustrated in FIG. 1G, including a tensioning strand in accordance withan alternative embodiment, showing on of the anchor bodies implanted inthe first configuration;

FIG. 16B is a schematic side elevation view of the anchor assembly asillustrated in FIG. 16A, but showing the implanted anchor body in theexpanded configuration;

FIG. 16C is a schematic side elevation view of the anchor assembly asillustrated in FIG. 16B, showing the other anchor body implanted in thefirst configuration;

FIG. 16D is a schematic side elevation view of the anchor assembly asillustrated in FIG. 16C, showing the other anchor body in the expandedconfiguration;

FIG. 16E is a schematic side elevation view of the anchor assembly asillustrated in FIG. 16D, showing locking of the locking member;

FIG. 16F is a schematic side elevation view of the anchor assembly asillustrated in FIG. 16E, show in a final assembled configuration;

FIG. 17A is a perspective view of a strand retention assemblyconstructed in accordance with one embodiment, showing a releasablelocking member;

FIG. 17B is a perspective view of the strand retention assemblyillustrated in FIG. 17A, showing a fixed locking member;

FIG. 17C is a perspective view of the strand retention assemblyillustrated in FIG. 17A, operably coupled to an actuator;

FIG. 17D is a perspective view of the strand retention assemblyillustrated in FIG. 17C, shown in a released position;

FIG. 18A is a schematic side elevation view of the anchor assembly asillustrated in FIG. 1G, including a pair of tensioning strands inaccordance with an alternative embodiment, showing the anchor bodies inthe first configuration;

FIG. 18B is a schematic side elevation view of the anchor assembly asillustrated in FIG. 18A, but showing the anchor bodies in the expandedconfiguration;

FIG. 18C is a schematic side elevation view of the anchor assembly asillustrated in FIG. 18B, showing actuation of a locking member andapproximation of an anatomical gap;

FIG. 18D is a schematic side elevation view of the anchor assembly asillustrated in FIG. 18C, showing locking of the locking member;

FIG. 18E is a schematic side elevation view of the anchor assembly asillustrated in FIG. 18D, show in a final assembled configuration;

FIG. 19A is a schematic sectional side elevation view of a retentionassembly of the insertion instrument constructed in accordance withanother embodiment, shown in a locked configuration;

FIG. 19B is a schematic sectional side elevation view of a retentionassembly of the insertion instrument illustrated in FIG. 19A, shown inan unlocked configuration;

FIG. 19C is a sectional side elevation view of the casing of aninsertion instrument similar to the insertion instrument as illustratedin FIG. 12C, but including a retention assembly constructed inaccordance with an alternative embodiment;

FIG. 20A is a sectional side elevation view of the insertion instrumentincluding a cutting assembly in accordance with another embodiment,showing the cutting assembly in a disengaged position;

FIG. 20B is a sectional side elevation view of the insertion instrumentas illustrated in FIG. 20A, but showing the cutting assembly in anengaged position;

FIG. 21A is a sectional side elevation view of the insertion instrumentas illustrated in FIG. 20A, but including a cutting assembly constructedin accordance with another embodiment, shown in a disengaged position;

FIG. 21B is a sectional side elevation view of the insertion instrumentas illustrated in FIG. 21A, but showing the cutting assembly in anengaged position;

FIG. 22A is a perspective view of the insertion instrument illustratedin FIG. 7A, but constructed in accordance with an alternativeembodiment, shown in the first position;

FIG. 22B is a side elevation view of the insertion instrument asillustrated in FIG. 22A;

FIG. 22C is a side elevation view of the insertion instrumentillustrated in FIG. 22B, but shown in a second position;

FIG. 22D is a side elevation view of the insertion instrumentillustrated in FIG. 22C, but shown in a third position;

FIG. 23A is a perspective view of an insertion instrument constructedsimilar to the insertion instrument illustrated in FIG. 7A, butconstructed in accordance with another embodiment, and shown in a firstposition;

FIG. 23B is a perspective view of a plunger of the insertion instrumentillustrated in FIG. 23A;

FIG. 23C is a perspective view of a distal end of the insertioninstrument illustrated in FIG. 23A;

FIG. 23D is a perspective view of various components of the insertioninstrument illustrated in FIG. 23A, including the plunger illustrated inFIG. 23B, a push rod, and a pair of first coupling members;

FIG. 23E is a perspective view of a second coupling member configured toengage the first coupling members illustrated in FIG. 23D;

FIG. 23F is a perspective view of the insertion instrument illustratedin FIG. 23A, shown in a second position;

FIG. 23G is a perspective view of the insertion instrument illustratedin FIG. 23F, shown in an intermediate position;

FIG. 23H is a perspective view of the insertion instrument illustratedin FIG. 23G, shown in a third position;

FIG. 24A is a perspective view of an insertion instrument includingfirst and second pusher assemblies disposed in a side-by-siderelationship, showing each of the pusher assemblies in a first position;

FIG. 24B is a perspective view of the insertion instrument illustratedin FIG. 24A, after removal of a first lockout tab from the first pusherassembly;

FIG. 24C is a perspective view of the insertion instrument illustratedin FIG. 24B, after actuation of the first pusher assembly to a secondposition;

FIG. 24D is a perspective view of the insertion instrument illustratedin FIG. 24C, after removal of a second lockout tab from the secondpusher assembly;

FIG. 24E is a perspective view of the insertion instrument illustratedin FIG. 24D, after actuation of a swap actuator;

FIG. 24F is a perspective view of the insertion instrument illustratedin FIG. 24E, after actuation of the second pusher assembly to a secondposition;

FIG. 25A is a perspective view of components of the insertion instrumentillustrated in FIG. 24A, showing each of the first and second pusherassemblies in the first position;

FIG. 25B is a perspective view of the components of the insertioninstrument illustrated in FIG. 25A, after the first pusher assembly hasbeen actuated to the second position;

FIG. 25C is a perspective view of the components of the insertioninstrument illustrated in FIG. 25B, after actuation of the swapactuator;

FIG. 25D is a perspective view of the components of the insertioninstrument illustrated in FIG. 25C, after the second pusher assembly hasbeen actuated to the second position;

FIG. 26A is a perspective view of a retention assembly constructed inaccordance with one embodiment;

FIG. 26B is an enlarged perspective view of a portion of the retentionassembly illustrated in FIG. 26A;

FIG. 27A is a perspective view of an insertion instrument constructed inaccordance with another embodiment, the insertion instrument includingfirst and second pusher assemblies disposed in a side-by-siderelationship, showing each of the pusher assemblies in a first position;

FIG. 27B is a perspective view of the insertion instrument illustratedin FIG. 27A, after actuation of the first pusher assembly to a positionconfiguration;

FIG. 27C is a perspective view of the components of the insertioninstrument illustrated in FIG. 27B, after actuation of the swap actuatorfrom a first position to an actuated position;

FIG. 27D is a perspective view of the insertion instrument illustratedin FIG. 27C, after actuation of the second pusher assembly to a secondposition;

FIG. 28A is a perspective view of components of the insertion instrumentillustrated in FIG. 27A, shown with the swap actuator in the firstposition;

FIG. 28B is a perspective view of components of the insertion instrumentillustrated in FIG. 28A, shown with the swap actuator in the secondposition;

FIG. 29A is a perspective view of an insertion instrument constructed inaccordance with another embodiment, the insertion instrument includingfirst and second pusher assemblies disposed in a side-by-siderelationship, showing each of the pusher assemblies in a first position;

FIG. 29B is an end elevation view of the insertion instrumentillustrated in FIG. 29A;

FIG. 29C is a perspective view of the insertion instrument illustratedin FIG. 29A, showing the first pusher assembly in a second position;

FIG. 29D is a perspective view of the insertion instrument illustratedin FIG. 29C, after actuation of a swap actuator from a first position toa second position;

FIG. 29E is a perspective view of the insertion instrument illustratedin FIG. 29D, after removal of a lockout tab from the second pusherassembly;

FIG. 29F is a perspective view of the insertion instrument illustratedin FIG. 29E, showing the second pusher assembly in a second position;

FIG. 29G is a schematic sectional end elevation view of the insertioninstrument illustrated in FIG. 29D, showing a portion of the swapactuator;

FIG. 30A is a perspective view of an insertion instrument constructed inaccordance with another embodiment, the insertion instrument includingfirst and second reciprocally movable cannulas, the drawing showing aportion of the casing cut away so as to expose internal components ofthe insertion instrument;

FIG. 30B is a perspective view of a reciprocal motion assembly of theinsertion instrument illustrated in FIG. 30A, the reciprocal motionassembly configured to reciprocally drive the first and second cannulas;

FIG. 30C is a perspective view of a drive member of the reciprocalmotion assembly illustrated in FIG. 30B;

FIG. 30D is a perspective view of a selective plunger engagementassembly configured to selectively move the plunger between operablycommunication with the first and second cannulas; and

FIG. 31 is a perspective view of an insertion instrument, wherein thecannula defines a side ejection port in accordance with anotherembodiment.

DETAILED DESCRIPTION

Referring initially to FIGS. 1A-B, an anchor assembly 20 can include atleast one expandable anchor 22 such as a first expandable anchor 22 aand a second expandable anchor 22 b that, in turn, include respectiveanchor bodies 28 a and 28 b that are configured to be secured to ananatomical location, which can be defined by at least one anatomicalstructure 24. The anatomical structure 24 can be defined by, forinstance, anatomy of a human or other animal, or an implant that issecured or configured to be secured to anatomy of a human or otheranimal. The anatomy can be defined by tissue that can include at leastone of bone and soft tissue such as a tendon, a ligament, cartilage, theannulus of an intervertebral disc, or the like.

In accordance with one embodiment, the at least one anatomical structure24 can define first and second target anatomical locations 24 a and 24 bon opposite sides of a gap, such as a gap 24 c. Thus, the gap 24 c canbe disposed in an anatomical structure, and can for instance define ananatomical defect, or can be disposed between different anatomicalstructures. First and second anchors 22 a and 22 b can be injected orotherwise driven or inserted into the respective first and second targetanatomical locations 24 a and 24 b on opposite sides of the gap 24 c,and subsequently drawn toward each other so as to approximate the gap 24c. Alternatively or additionally still, the anchor assembly 20 can beconfigured to secure an auxiliary structure to the anatomical structure.In this regard, it should be further appreciated that the anchorassembly 20 can include any number of anchors 22 as desired.

Each anchor body 28 a and 28 b can include a respective expandableportion 36 a and 36 b, and an actuation member 37 a and 37 b, such as anactuation strand 38 a and 38 b, that is configured to actuate therespective expandable portion 36 a and 36 b, and thus the respectiveanchor body 28 a and 28 b, from a first configuration illustrated inFIG. 1A, whereby the anchor body 28 a and 28 b is initially placed atthe target anatomical location, to an expanded configuration illustratedin FIG. 1B, whereby the respective anchor body 28 a and 28 b can besecured to the anatomical structure 24. Thus, the anchor bodies 28 a and28 b of the anchors 22 a and 22 b can be inserted through an opening 23at the respective target anatomical locations 24 a and 24 b that can becreated, for example, when delivering the anchor bodies 28 a and 28 b tothe respective target anatomical locations 24 a and 24 b, for instanceby injecting the anchor bodies 28 a and 28 b to the respective targetanatomical locations 24 a and 24 b.

The expandable portion 36 of the anchor body 28 extends along thedirection of elongation 34 so as to define an initial distance D1 asmeasured from the proximal end 39 a to the distal end 39 b along thedirection of elongation 34 when in the first configuration. The initialdistance D1 can be any length as desired, such within a range having alower end that can be defined by approximately 5 mm, alternativelyapproximately 10 mm, alternatively still approximately 20 mm, andalternatively still approximately 24.5 mm, and having an upper end thatcan be defined by approximately 50 mm, alternatively approximately 40mm, alternatively still approximately 30 mm, and alternatively stillapproximately 25.5 mm.

Furthermore, when in the first configuration, the expandable portion 36defines an initial maximum thickness T1 that extends in a seconddirection 35 that is substantially perpendicular, with respect to thedirection of elongation 34. The initial maximum thickness T1 can besized as desired. As illustrated in FIG. 1B, when the expandable portion36 in the expanded configuration, the expandable portion 36 iscollapsed, for instance compressed or tangled, along the direction ofelongation 34 to a second distance D2 as measured from the proximal end39 a to the distal end 39 b along the direction of elongation 34. Thesecond distance D2 can be less than the initial distance D1. As theexpandable portion 36 collapses along the direction of elongation, forinstance as it is actuated from the first configuration to the expandedconfiguration, the expandable portion 36 expands along the seconddirection 35 to a second maximum thickness T2 that is greater than theinitial maximum thickness T1. The second maximum thickness T2 extendsalong the second direction 35 which is substantially perpendicular tothe direction of elongation 34.

The maximum thicknesses T1 and T2 in the second direction 35 can bedefined such the anchor body 28 does not define a thickness in thesecond direction 35 that is greater than the maximum thicknesses T1 andT2, respectively. It should be appreciated that the proximal and distalends 39 a and 39 b can change locations on the expandable portion 36 asthe expandable portion 36 actuates to the expanded configuration, forinstance due to configuration of the expandable portion 36 when in theexpanded configuration. However, when the expandable portion 36 is inthe expanded configuration, the proximal and distal ends 39 a and 39 bcontinue to define the proximal-most and distal-most ends of theexpandable portion 36, such that the distance D2 along the direction ofelongation 34 is defined linearly between the proximal and distal ends39 a and 39 b of the expandable portion 36 when the expandable portion36 is in the expanded configuration.

Each of the actuation strands 38 of the first and second anchors 22 aand 22 b can be attached to each other. For instance, the actuationstrand 38 of the first anchor 22 a can be integral with the actuationstrand 38 of the second anchor 22 b. Alternatively, as will be describedin more detail below with reference to FIGS. 2A-C, the actuation strand38 of the first anchor 22 a can be separate from the actuation strand 38of the second anchor 22 a, such that the actuation strands 38 of thefirst and second anchors 22 a and 22 b are subsequently attached,directly or indirectly, using any suitable connector member 63. Theconnector member 63 can be integral with either or both of the actuationstrands 38 a and 38 b or can be separately attached to each of theactuation strands 38 a and 38 b. In accordance with one embodiment, theactuation strands 38 a and 38 b of each of the first and second anchors22 a and 22 b defines at least one respective actuation portion 131 aand 131 b and can further include at least one respective attachmentportion 133 a and 133 b. The actuation portions 131 a and 131 b are eachconfigured to receive an actuation force that causes the respectiveanchor 22 a and 22 b to actuate from the first configuration to theexpanded configuration.

In accordance with the illustrated embodiment, the attachment portions133 a and 133 b of the actuation strands 38 a and 38 b of the first andsecond anchors are configured to be attached to each other so as to spanacross the gap 24 c and attach the first anchor body 28 a to the secondanchor body 28 b. The attachment portions 133 a and 133 b can beintegral with each other, or attached to each other using any suitableconnector member. Furthermore, in accordance with the illustratedembodiment, the actuation portions 131 a and 131 b can also defineattachment portions that are configured to be attached to each other inany suitable manner, either before or after the actuation force F isapplied to the actuation portions 131 a and 131 b. Thus, the attachmentportion 133 a and 133 b of a respective anchor 22 a and 22 b isconfigured to attach the respective anchor to another anchor, such as anattachment portion of the other anchor. Furthermore, the actuationportion 131 a of the first anchor 22 a is configured to attach therespective anchor 22 a to the second anchor 22 b. In accordance with theillustrated embodiment, the attachment portion 133 a of the actuationstrand 38 a of the first anchor 22 a is integral with the attachmentportion 133 b of the actuation strand 38 b of the second anchor 22 b,though it should be appreciated that the attachment portions 133 a-b ofthe first and second anchors 22 a-b can be separate from each other andattached to each other, as described in more detail below.

With continuing reference to FIGS. 1A-B, once the expandable portions 36a-b of the anchors 22 a-b have actuated to the expanded configuration,the actuation strands 38 a-b can be placed in tension. For instance, inaccordance with one embodiment, an approximation Force AF can be appliedto either or both of the actuation portion 131 a-b of the actuationstrands 38 a-b of the first and second anchors 22 a-b, thereby inducinga tension in the actuation strands 38 a-b of the first and secondanchors 22 a-b so as to apply a biasing force that draws the first andsecond anchors 22 a and 22 b toward each other. Accordingly, if a gap 24c is disposed between the first and second anchors 22 a and 22 b,movement of the anchors 22 a and 22 b toward each other in response tothe biasing force approximates the gap 24 c which, in certainembodiments, can be an anatomical defect, such as a tissue defect asdescribed above.

Furthermore, when the actuation strands 38 a-b are maintained in tensionafter the defect 24 has been approximated, the anchor bodies 28 a-b areprevented from backing out from the anatomy through the respectivetarget locations 24 a-b, which could allow the gap 24 c to open. Thus,once the gap 24 c has been approximated, the actuation strand 38 a ofthe first anchor 22 a can be attached to the actuation strand 38 b ofthe second anchor 22 b so as to maintain tension between the first andsecond anchors 22 a and 22 b and prevent the first and second anchors 22a and 22 b from separating.

The anchor bodies 28 a and 28 b can be constructed by weaving anysuitable substrate, such as a strand, for instance a strand of suture,in any manner desired so as to produce a plurality of openings 43 thatextend through the respective anchor bodies 28 a and 28 b. The first andsecond actuation strands 38 a and 38 b can be woven through at least twoof the openings 43 along the direction of elongation 34 of the anchorbodies 28 a and 28 b.

In accordance with the embodiment illustrated in FIGS. 1A-1F, the firstand second actuation strands 38 a and 38 b are integral with therespective first and second anchor bodies 28 a and 28 b. In accordancewith other embodiments, the first and second actuation strands 38 a and38 b are illustrated as separate from and attached to the respectivefirst and second anchor bodies 28 a and 28 b (see FIG. 2C). Inaccordance with still other embodiments, one of the first and secondactuation strands 38 a and 38 b is integral with the respective anchorbody and the other of the first and second actuation strands 38 a and 38b is separate from and attached to the respective anchor body. Inaccordance with embodiments whereby the first and second actuationstrands 38 a and 38 b are illustrated and described as integral with therespective first and second anchor bodies 28 a and 28 b, it should beappreciated that the first and second actuation strands 38 a and 38 bcan alternatively be separate from and attached to the respective firstand second anchor bodies 28 a and 28 b, unless otherwise indicated.Furthermore, in accordance with embodiments whereby the first and secondactuation strands 38 a and 38 b are illustrated and described asseparate from and attached to the respective first and second anchorbodies 28 a and 28 b, it should be appreciated that the first and secondactuation strands 38 a and 38 b can alternatively be integral with therespective first and second anchor bodies 28 a and 28 b, unlessotherwise indicated.

Referring to FIGS. 1C-1F, the anchor assembly 20 can include at leastone connector member 63 that is configured to join the anchors 22 andallow a biasing force to be applied to at least one of the anchors 22 aand 22 b that draws the anchors 22 a and 22 b together, therebyapproximating the anatomical defect 24. The connector member 63 can beintegral with one or both of the first and second anchors 22 a and 22 b,for instance integral with one or both of the first and second actuationstrands 38 a and 38 b, can be integral with one or both of the first andsecond anchor bodies, or can be separate from and attached (directly orindirectly) to one or both of the first and second anchors 22 a and 22b. For instance, the connector member 63 can be separate from andattached between the first and second anchors 22 a and 22 b, as will bedescribed in more detail below. While connector members 63 are describedherein in accordance with various embodiments, it should be appreciatedthat the anchor assembly 20 can alternatively include any suitableconnector member configured to attach the first anchor 22 a to thesecond anchor 22 b.

The anchor assembly 20 can include a connector member 63 that isintegral with the corresponding actuation strands 38 a and 38 b. Asdescribed above, each of the first and second anchor bodies 28 a and 28b can be implanted at respective first and target anatomical locations24 a and 24 b that are disposed on opposite sides of a gap 24 c asillustrated in FIG. 2A. Each of the first and second actuation strands38 a and 38 b can receive an actuation force F substantially along thedirection of elongation 34 that causes the respective first and secondanchor bodies 28 a and 28 b, and in particular the respective expandableportions 36 a and 36 b, to actuate from the first configuration to theexpanded configuration so as to fix the first and second anchor bodies28 a and 28 b at the respective first and second target anatomicallocations 24 a and 24 b. The actuation force F applied to each of theactuation strands 38 a and 38 b can be in the form of differentactuation forces, or can be the same actuation force.

For instance, referring to FIGS. 1C-1D, the connector member 63 can beconfigured as an auxiliary connector member 77, that is a connectormember that is separate from one or both of the first and secondactuation strands 38 a and 38 b and configured to attach to the firstand second actuation strands 38 a and 38 b to each other. For instance,the auxiliary connector member 77 can be made from any suitable metal,plastic, or any alternative biocompatible material, and can beconfigured as a body 146, which can be flexible or rigid, that isconfigured to attach to either or both of the first actuation strands 38a and 38 b, and in particular to the actuation portions 131 a-b, at alocation between the anchors 22 a and 22 b. For instance, each of thefirst and second actuation portions 131 a-b can be stitched through thebody 146 and tied about the body 146 so as to define a knot 148 that canbe actuated from an unlocked configuration to a locked configuration.The first and second actuation portions 131 a-b are slidable withrespect to the body 146 when the knots 148 are in the unlockedconfiguration, and fixed with respect to sliding movement relative tothe body 146 when the knots 148 are in the locked configuration. Thebody 146 can define any shape as desired, such as substantiallycylindrical, and can be flexible or substantially rigid as desired.

During operation, the actuation portions 131 a-b can be stitched throughthe body 146 along a direction away from the anatomical structure 24 andtied about the body 146 such that the respective knots 148 are in theunlocked configuration. The body 146 can be oriented such that its longaxis 149 is oriented substantially parallel to the anatomical structure24. The body 146 can be translated along the first and second actuationstrands 38 a and 38 b along the direction of Arrow 150 toward theanatomical structure 24 while the actuation strands 38 a and 38 b areunder tension, which causes the actuation strands 38 a and 38 b totranslate relative to the body 146 along an opposite direction indicatedby Arrow 152. As the body 146 translates along the actuation strands 38a and 38 b toward the gap 24 c, the body 146 applies the actuation forceF to the actuation strands 38 a and 38 b, thereby causing the anchors 22a and 22 b to actuate from the first configuration to the expandedconfiguration.

As the body 146 further translates toward the gap 24 c after the anchors22 a and 22 b have been actuated to their expanded configuration, thebody 146 applies the approximation force AF to at least one or both ofthe actuation strands 38 a and 38 b that draws at least one or both ofthe anchors 22 a and 22 b inward toward the other, thereby approximatingthe gap 24 c. In this regard, it should be appreciated that theapproximation force AF can be a continuation of the actuation force F.Alternatively, the actuation force F can be applied to the actuationstrands 38 a and 38 b at a location upstream of the body 146, or priorto attaching the actuation strands 38 a and 38 b to the body 146. Theknot 148 can then be tightened so as to secure the first and secondactuation strands 38 a and 38 b to the body 146, and therefore also toeach other so as to prevent separation of the first and second anchors22 a and 22 b. Once the gap 24 c has been approximated, the body 146,and thus the knots 148, can be disposed along the outer surface of theanatomical structure 24. Alternatively, the body 146 can be sized suchthat a portion of the body 146, and thus the knots 148, is disposed inthe opening 23 that receives the anchor bodies 28 a and 28 b once thegap 24 c has been approximated. Accordingly, the knots 148 can bedisposed behind the anatomical structure 24, or can be embedded in theanatomical structure 24.

The body 146 can thus define a sliding member 47 that allows one of thefirst and second actuation strands 38 a and 38 b to slide with respectto the other of the first and second actuation strands 38 a and 38 b soas to approximate the gap 24 c, and can further define a locking member64 that secures the first and second actuation strands 38 a and 38 b toeach other, for example with respect with respect to relative movementthat would allow the first and second anchor bodies 28 a and 28 b toseparate.

Referring now to FIGS. 1E-1F, the anchor assembly 20 can include a pairof connector members 63 a and 63 b configured to attach at least one orboth of the actuation portions 131 a and 131 b to the respectiveattachment portions 133 a and 133 b. In accordance with the illustratedembodiment, the actuation strands 38 a and 38 b are defined by a commonactuation member, such as a common strand, which can be an auxiliarystrand 33 that is separate from, and woven through, at least one such asa pair or a plurality of openings of both the first and second anchorbodies 28 a-b, such that the respective attachment portions 133 a and133 b are integral with each other. Thus, in accordance with theillustrated embodiment, the first and second actuation strands 38 a and38 b are integral with each other. The anchor assembly 20 can includefirst and second connector members 63 a and 63 b that are defined by theactuation strands 38 a and 38 b, and are configured to attach theactuation portions 131 a and 131 b to other locations of the commonstrand, and thus to each other. In accordance with the illustratedembodiment, the first and connector member 63 a can attach thecorresponding first actuation portion 131 a to another location of theauxiliary strand 33 that is spaced from the first actuation portion 131a. Likewise, the second and connector member 63 b can attach thecorresponding second first actuation portion 131 b to another locationof the auxiliary strand 33 that is spaced from the second firstactuation portion 131 b. For instance, in accordance with theillustrated embodiment, the first connector member 63 a attaches thefirst actuation portion 131 a to the first attachment portion 133 a, andthe second connector member 63 b attaches the second actuation portion131 b to the second attachment portion 133 b.

Thus, it can be said that at least one connector member, such as thefirst and second connector members 63 a and 63 b, can attach the firstand second actuation portions 131 a and 131 b to respective otherlocations of the auxiliary strand 33 so as to attach the first andsecond actuation portions 131 a and 131 b to each other, for instanceindirectly through at least one or both of the attachment portions 133 aand 133 b. It can further be said that the first connector member 63 aoperably attaches one portion of the first actuation strand 38 a toanother location of the actuation strand 38 a, and the second connectormember 63 b operably attaches one portion of the second actuation strand38 b to another location of the second actuation strand 38 b.Alternatively, it should be appreciated that the first and secondconnector members 63 a and 63 b can attach the respective first andsecond actuation portions 131 a and 131 b to the anchor body 28, such asat respective first and second end portions 52 and 54. While theactuation strands 38 a and 38 b are illustrated as separate from eachother, the actuation strands 38 a and 38 b can alternatively be attachedto each other, for instance via any suitable connector member 63 of thetype described herein, so as to define an outer connector strand.

In accordance with the illustrated embodiment, each of the first andsecond connector members 63 a and 63 b can be configured as respectiveknots 66 a and 66 b that are defined by the auxiliary strand 33. Inaccordance with the illustrated embodiment, the first knot 66 a includesa post end 68, which can be defined by the actuation portion 131 a ofthe first actuation strand 38 a, and a free end, which can include astatic portion 70 a that is defined by a first end 137 a of the firstattachment portion 133 a and a free portion 70 b that is defined by asecond end 139 a of the first attachment portion 133 a. The first end137 a can be disposed between the knot 66 a and the first anchor body 28a, and the second end 139 a can be disposed between the knot 66 a andthe second connector member 63 b. Alternatively, the free portion 70 bcan be defined by the attachment portion 133 b of the second actuationstrand 38 b.

In accordance with one embodiment, the second knot 66 a includes a postend 68, which can be defined by the actuation portion 131 b of thesecond actuation strand 38 b, and a free end, which can include a staticportion 70 a that is defined by a first end 137 b of the secondattachment portion 133 b and a free portion 70 b that is defined by asecond end 139 b of the second attachment portion 133 b. The first end137 b can be disposed between the knot 66 b and the second anchor body28 b, and the second end 139 b can be disposed between the knot 66 b andthe first connector member 63 a. Alternatively, the free portion 70 bcan be defined by the attachment portion 133 a of the first actuationstrand 38 a. The attachment portions 133 a and 133 b are illustrated asbeing integral with each other, though it should be appreciated that theattachment portions 133 a and 133 b can be separate and attached to eachother as desired.

Each of the first and second knots 66 a and 66 b can define respectivesliding members 47 that allow the respective post ends 68 to translatetherethrough relative to the free ends. Thus, the sliding members 47allow the first and second actuation portions 131 a and 131 b totranslate relative to the first and second attachment portions 133 a and133 b, for instance in response to the applied actuation force F whenthe knots 66 a and 66 b are in unlocked configurations, therebyactuating the respective anchor body 28 a and 28 b from the firstconfiguration to the expanded configuration. Each knot 66 furtherdefines a locking member 64 that can be actuated to a lockedconfiguration so as to secure the at least one or both of the anchors 22a and 22 b in their respective biased positions. For instance, a tensilelocking force can be applied to the free portions 70 b of the free endsof the knots 66 a and 66 b so as to prevent the actuation portions 131 aand 131 b from translating through the knots 66 a and 66 b relative tothe attachment portions 133 a and 133 b.

The first and second knots 66 a and 66 b can be spaced apart a fixeddistance L along the auxiliary strand 33, such that the gap 24 c ismaintained approximated when the anchor bodies 22 a and 22 b areinserted into the respective target anatomical locations 24 a and 24 b.For instance, the gap 24 c can be approximated prior to injecting theknots 66 a and 66 b into the respective target anatomical locations 24 aand 24 b. During operation, once the first and second anchors 22 a and22 b are implanted at the respective first and second target anatomicallocations 24 a and 24 b, the knots 66 a-b can be in an unlockedconfiguration such that application of the actuation force F to therespective actuation strands 38 a-b, for instance the actuation portions131 a-b, causes the respective anchor bodies 28 a-b to actuate from thefirst configuration to the expanded configuration. Next, a tensilelocking force can be applied to the respective attachment portions 133a-b against the corresponding knots 66 a-b, so as to actuate the knots66 a-b to their locked configurations and maintain the anchor 22 a-b intheir expanded configurations.

The distance L between the first and second knots 66 a and 66 b can besubstantially equal to or less than the distance between the targetanatomical locations 24 a and 24 b, such that the gap 24 c isapproximated when the first and second anchors 22 a and 22 b areexpanded behind the anatomy and joined by the auxiliary strand 33, suchthat tension induced in the actuation strands 38 a and 38 b maintainsthe approximation of the gap 24 c. While the first and second connectormembers 63 a-b can be configured as respective knots 66, it should beappreciated that either or both of the first and second connectormembers 63 a and 63 b can be alternatively configured as any suitablelocking member 63 of any type described herein or any suitablealternatively constructed locking member. For instance, at least one orboth of the connector members 63 a-b can define a splice, whereby therespective actuation strands 38 a-b can be spliced through the other ofthe actuation strands 38 a-b or itself, and the connector strand isplaced in tension after actuation of the anchors 22 a and 22 b so as toapply a compressive force that prevents translation of the anchorstrands 38 a-b.

It should be appreciated that the anchor bodies 28 a and 28 b can beconstructed in accordance with any suitable embodiment as desired. Forinstance, referring now to FIGS. 1G-1H, each of the anchor bodies 28 aand 28 b can include an eyelet 90 that extends from a distal end of therespective expandable portions 36 a and 36 b. The actuation strand 38can be configured as an auxiliary strand 33 that is separate from theanchor bodies 28. The actuation strand can be woven through the anchorbodies 28 a and 28 b, and can extend through the respective eyelets 90 aand 90 b so as to define a path for the eyelets 90 a and 90 b to travelthrough the respective anchor bodies 28 a and 28 b when the anchorbodies 28 a and 28 b are actuated from the first configuration to theexpanded configuration. The auxiliary strand 33 can thus attach thefirst anchor body 28 a to the second anchor body 28 b, and can furtherbe configured to receive the actuation force F that cases the anchorbodies 28 a and 28 b to actuate from the first configuration to theexpanded configuration once implanted in the respective targetanatomical locations 24 a and 24 b.

As described above, the anchor assembly 20 can include any suitableconnector member 63 that can be configured to attach to the first andsecond actuation portions 131 a and 131 b, thereby attaching the firstand second actuation strands 38 a and 38 b to each other, and alsoattaching the anchors 22 a and 22 b to each other. The first and secondactuation strands 38 a and 38 b are illustrated as integral with eachother, and thus define a common actuation strand. Alternatively, thefirst and second actuation strands 38 a and 38 b can be separate fromeach other and attached to each other in any manner desired.

In accordance with the embodiment illustrated in FIGS. 1G-H, theconnector member 63 is defined by and integral with the first and secondactuation strands 38 a and 38 b. Thus, the actuation portions 131 a and131 b of the actuation strands 38 a and 38 b are attached directly toeach other. The connector member 63 can define a sliding member 47 and alocking member 64 at a junction 125. For instance, the connector member63 can define a knot 66 that can be constructed as desired, and can bedefined by one or both of the actuation strands 38 a and 38 b. Thus, atleast a portion of the connector member 63 can be integral with at leastone or both of the actuation strands 38 a and 38 b.

One of the first and second actuation strands 38 a and 38 b can definethe post end 68 of the knot 66, and the other of the first and secondactuation strands 38 a and 38 b can define the free end 70 of the knot66. In accordance with the illustrated embodiment, the first actuationstrand, such as the first actuation portion 131 a, defines the post end68 and the second actuation strand 38 b, such as the second actuationportion 131 b, defines the free end 70.

The first and second actuation strands 38 a and 38 b can be tied intothe knot 66 prior to applying tension to the actuation strands 38 a and38 b that biases the first and second anchors 22 a and 22 b toward eachother and approximates the gap 24 c. Once the knot 66 is formed, andwhen the knot 66 is in an unlocked configuration, the actuation force Fcan be applied to the actuation strands 38 a and 38 b, and in particularto the actuation portions 131 a-b, so as to actuate the respectiveexpandable portions 36 from the first configuration to the expandedconfiguration. Next, the approximation force AF can be applied to theterminal portion 135 a of the first actuation strand 38 a, which definesthe post strand 68, thereby causing the post end 68 to slide through theknot 66 and draw the respective anchor, such as the first anchor 22 a,toward the other anchor, such as the second anchor 22 b. Once the gap 24c has been approximated, the free strand 70 b of the free end 70, forinstance defined by the terminal portion 135 b of the second actuationstrand 38 b, can be placed in tension so as to lock knot 66 and preventthe first actuation strand 38 a from translating through the knot 66,thereby fixing the actuation strands 38 a and 38 b in tension. While theconnector member 63 can be configured as the knot 66, it should beappreciated that the connector member 63 can alternatively be configuredin accordance with any embodiment described herein or any suitablealternative connector as desired.

Referring now to FIGS. 2A-C, and as generally described above withrespect to FIGS. 1A-B, the anchor assembly 20 can include first andsecond anchors 22 a and 22 b. The first anchor 22 a includes a firstanchor body 28 a that extends substantially along the direction ofelongation 34 and defines a first plurality of openings 40 a that extendthrough the first anchor body 28 a. The first anchor 22 a furtherincludes a first actuation strand 38 a that extends through at least oneof the openings 40 a, such as a plurality of the openings, and isconfigured to receive an actuation force F that causes the first anchorbody 28 a to actuate from the first configuration to the expandedconfiguration in the manner described above. The first actuation strand38 a can be separate from and attached to, for instance woven throughopenings of, the first anchor body 28 a, or can be integral with thefirst anchor body 28 a and extend through openings of the first anchorbody 28 a.

The second anchor 22 b includes a second anchor body 28 b that extendssubstantially along the direction of elongation 34 and defines a secondplurality of openings 40 b that extend through the second anchor body 28b. The second anchor 22 b further includes a second actuation strand 38b that extends through at least one of the openings 40 b, such as aplurality of the openings, and is configured to receive an actuationforce F that causes the second anchor body 28 b to actuate from thefirst configuration to the expanded configuration in the mannerdescribed above. The second actuation strand 38 b can be separate fromand attached to, for instance woven through openings of, the secondanchor body 28 b, or can be integral with the second anchor body 28 band extend through openings of the second anchor body 28 b.

In accordance with the embodiment illustrated in FIGS. 2A-B, the firstand second actuation strands 38 a and 38 b are integral with therespective first and second anchor bodies 28 a and 28 b. In accordancewith other embodiments, the first and second actuation strands 38 a and38 b are illustrated as separate from and attached to the respectivefirst and second anchor bodies 28 a and 28 b. In accordance with stillother embodiments, one of the first and second actuation strands 38 aand 38 b is integral with the respective anchor body and the other ofthe first and second actuation strands 38 a and 38 b is separate fromand attached to the respective anchor body. In accordance withembodiments whereby the first and second actuation strands 38 a and 38 bare illustrated and described as integral with the respective first andsecond anchor bodies 28 a and 28 b, it should be appreciated that thefirst and second actuation strands 38 a and 38 b can alternatively beseparate from and attached to the respective first and second anchorbodies 28 a and 28 b, unless otherwise indicated. Furthermore, inaccordance with embodiments whereby the first and second actuationstrands 38 a and 38 b are illustrated and described as separate from andattached to the respective first and second anchor bodies 28 a and 28 b,it should be appreciated that the first and second actuation strands 38a and 38 b can alternatively be integral with the respective first andsecond anchor bodies 28 a and 28 b, unless otherwise indicated.

With continuing reference to FIG. 2C, the anchor assembly 20 can includeat least one connector member 63 that is configured to join the anchors22 and allow a biasing force to be applied to at least one of theanchors 22 a and 22 b that draws the anchors 22 a and 22 b together,thereby approximating the anatomical defect 24. The connector member 63can be integral with one or both of the first and second anchors 22 aand 22 b, for instance integral with one or both of the first and secondactuation strands 38 a and 38 b, can be integral with one or both of thefirst and second anchor bodies, or can be separate from and attached(directly or indirectly) to one or both of the first and second anchors22 a and 22 b. For instance, the connector member 63 can be separatefrom and attached between the first and second anchors 22 a and 22 b, aswill be described in more detail below. While connector members 63 aredescribed herein in accordance with various embodiments, it should beappreciated that the anchor assembly 20 can alternatively include anysuitable connector member configured to attach the first anchor 22 a tothe second anchor 22 b. At least one or both of the actuation strands 38a-b can be configured to receive an approximation force AF that biasesat least one of the first and second anchors 22 a and 22 b toward theother so as to approximate the gap 24 c.

The anchor assembly 20 can include a connector member 63 that isintegral with the corresponding actuation strands 38 a and 38 b. Asdescribed above, each of the first and second anchor bodies 28 a and 28b can be implanted at respective first and target anatomical locations24 a and 24 b that are disposed on opposite sides of a gap 24 c asillustrated in FIG. 2A. Each of the first and second actuation strands38 a and 38 b can receive an actuation force F substantially along thedirection of elongation 34 that causes the respective first and secondanchor bodies 28 a and 28 b, and in particular the respective expandableportions 36 a and 36 b, to actuate from the first configuration to theexpanded configuration so as to fix the first and second anchor bodies28 a and 28 b at the respective first and second target anatomicallocations 24 a and 24 b. The actuation force F applied to each of theactuation strands 38 a and 38 b can be in the form of differentactuation forces, or, as is described in more detail below, can be thesame actuation force.

Referring now to FIG. 2B, once the first and second anchor bodies 28 aand 28 b are secured to the respective first and second targetanatomical locations 24 a and 24 b, an approximation force AF can beapplied to at least one or both of the first and second actuationsegments 38 a and 38 b substantially along a direction toward the otherof the respective first and second anchor bodies 28 a and 28 b, whichcan also be toward the respective gap 24 c. Thus the approximation forceAF can have a directional component that is toward the other of therespective first and second anchor bodies 28 a and 28 b, for instancecan be directed purely toward the other of the first and second anchorbodies 28 a and 28 b. Likewise, the approximation force AF can have adirectional component that is directed toward the gap 24 c, for instancedirected purely toward the gap 24 c. Accordingly, the approximationforce AF biases at least one or both of the anchor bodies 28 a and 28 btoward the other of the anchor bodies 28 a and 28 b to respective biasedpositions that to approximate the gap 24 c.

Referring again to FIG. 2C, the connector member 63 that can define atleast one or both of a sliding member 47 and a locking member 64 thatattaches the first and second connector actuation strands 38 a and 38 btogether, for instance at a junction 125. Thus, it should be appreciatedthat the at least one of the sliding member 47 and locking member 64 canlikewise attach the first actuation strand 38 a to the second actuationstrand 38 b. In accordance with one embodiment, the connector member 63can attach the first and second actuation strands 38 a and 38 b afterthe first and second actuation strands 38 a and 38 b have been put undertension so as to maintain the gap 24 c in an approximated state. Themember 63 can be actuated to the locked configuration so as to preventor resist separation of the first and second anchors 22 a and 22 b thatwould cause the gap 24 c to open from the approximated state.Alternatively or additionally, the connector member 63 can attach thefirst and second actuation strands 38 a and 38 b to each other prior toapplying the approximation force AF to the actuation strands 38 a and 38b, and placing the actuation strands 38 a and 38 b under tension, andtherefore prior to approximating the gap 24 c.

In accordance with certain embodiments, the connector member 63 isdefined by, and integral with, the first and second actuation strands 38a and 38 b, and can be configured as a sliding and locking knot that caniterate from an unlocked configuration, whereby one of the actuationstrands 38 a and 38 b to slide relative to the other so as toapproximate the gap 24 c, and a locked configuration, whereby theactuation strands 38 a and 38 b are prevented from sliding relative toeach other through the knot. The connector member 63 defines the atleast one of the sliding member 47 and the locking member 64 at thejunction 125. Thus, it can be said that the connector member 63 candirectly or indirectly attach the first and second actuation strands 38a and 38 b together.

Referring now to FIG. 3A, a fixation assembly 250 can include the anchorassembly 20, such as at least one anchor 22, and an insertion instrument252 configured to inject the anchor 22 in the anatomical structure 24 asillustrated in FIGS. 1A-B. It should be appreciated that the fixationkit 250 can include at least one or more up to all of the anchors 22described herein alone, attached to each other, or configured to beattached to each other in accordance with any of the embodimentsdescriber herein. The insertion instrument 252 can include a cannula 254with a central opening 256 and a first pusher member such as a plungeror push rod 258 which is coaxially insertable into the central opening256. the cannula 254 has an acuminated tip 260 and a slot 268 extendingaxially from the tip 260. The cannula 254 can extends substantiallystraight as illustrated, or can be curved or define any suitable shapeas desired so as to eject an anchor body 28.

Further, the insertion instrument 252 comprises a handle 262 with anoperating lever 264. One end of the handle 262 is detachably attached tothe cannula 254 and the operating lever 264 is detachably attached tothe plunger 258. The outer diameter of the plunger 258 corresponds tothe inner diameter of the central opening 256 of the cannula 254. At therear end the central opening of the cannula 254 is conically configuredin such a manner that it enlarges towards the rear end of the cannula254 at an inlet 266. Thus, the anchor body 28 of the anchor 22 can beinserted in its first configuration through the conical inlet 266 andinto the central opening 256 of the cannula 254, such that the anchorbody 28 can be compressed.

When the anchor body 28 is pressed out of the cannula 254 by pressingthe plunger 258 forward the anchor body 28 can radially expand, forinstance in the second direction 35 (see FIGS. 1A-B) in such a mannerthat it can be retained by the front face of the cannula 254 when atensile force is exerted onto the actuation strand 38 in order totighten the anchor body 28. the actuation strand 38 is led through theslot 268 so that it can be led alongside the cannula 254 when thecannula 254 is inserted into the anatomical structure 24. At the freeend of the actuation strand 38 a needle 270 is attached that can be usedfor finishing a surgical procedure when the anchor body 28 of the anchor22 has been actuated to the expanded configuration and secured to theanatomical structure 24.

Referring to FIG. 3B, the plunger 258 can have an outer diameter oralternative cross-sectional dimension that is less than the innerdiameter or cross-sectional dimension of the central opening 256 of thecannula 254. The actuation strand 38 of the anchor 22 can thus be ledthrough the central opening 256 of the cannula 254 when the plunger 258is inserted in the central opening 256 of the cannula 254. By actuatingthe operating lever 264 at the handle 262, the plunger 258 can push theanchor 22 forward in the cannula 254 as far as the anchor body 28 exitsfrom the central opening 256 at the tip 260 of the cannula 254. Once theanchor body 28 is positioned in the central opening 256 the actuationstrand 38 can be pulled backward at the rear end of the cannula 254 sothat the anchor body 28 can be actuated in the cavity 256 to itsexpanded configuration.

Referring to FIGS. 4A-D, the plunger 258 can define a central bore 272where the actuation strand 38 of the anchor 22 can be led through.Further, the cannula 254 has a first longitudinal aperture 274 extendingbetween the tip 260 and the rear end of the cannula 254 so that thecannula 254 is slotted over its entire length. A second longitudinalaperture 276 extends on the plunger 258 between the front end and therear end of the plunger 258 so that the plunger 258 is slotted over itsentire length as well. As shown in FIG. 4B when the cannula 254 is in afirst rotative position relative to the plunger 258 the firstlongitudinal aperture 274 of the cannula 254 is diametrically oppositeto the second longitudinal aperture 276 of the plunger 258. In the firstrotative position of the cannula 254 the actuation strand 38 of theanchor 22 is retained by the central bore 272. Once the anchor body 28of the anchor 22 has been fixed in a cavity of a patient's body bypulling the actuation strand 38 of the anchor 22 backward the cannula254 can be rotated into a second rotative position relative to theplunger 258 (FIG. 4D). In this second rotative position of the cannula254 the first longitudinal aperture 274 of the cannula 254 is alignedwith the second longitudinal aperture 276 of the plunger 258 and theinsertion instrument 252 can be released from the actuation strand 38 ofthe anchor 22.

FIGS. 5A-D illustrate the handle 262 and the attachment of the cannula254 to the handle 262 of an embodiment of the insertion instrument 252of FIGS. 3A to 4D. The upper end portion of the handle 262 comprises agroove 278 into which the cannula 254 can be inserted and a springmember such as a leaf spring 279 so as to provide a releasable snap lockconfigured to releasably attach the cannula 254 to the handle 262. Therear end of the plunger 258 can be snapped into a resilient fork 280arranged at the upper end of the operating lever 264.

Referring to FIG. 6, the insertion instrument 52 can include a depthcontrol tube 282 slid over the cannula 254 and a clamping element 284.The insertion instrument 52 is pre-operatively prepared by inserting theanchor 22 into the cannula 254 and inserting the plunger 258. Once theanchor 22 and the plunger 258 have been inserted any one of a pluralityof clamping elements 284 is attached to the rear end of the insertioninstrument 252 by snapping a first tab 286 onto the rear portion of thecannula 254. To prevent an unintended displacement of the plunger 258relative to the cannula 254 the clamping element 284 comprises a secondtab 288 which abuts the rear end of the cannula 254 and a third tab 290which abuts an enlarged portion at the rear end of the plunger 258.Before using the insertion instrument 252, the clamping element 284 isremoved from the cannula 254 and the handle 262 is attached to thecannula 254, and the insertion instrument 252 can be operated in themanner described herein.

Referring now to FIGS. 1A and 7A-D, an insertion instrument 300constructed in accordance with an alternative embodiment is configuredto deliver at least one anchor knot, such as the first and second anchorknots 22 a and 22 b, to a respective target location, such as targetlocations 24 a and 24 b (FIG. 1A). The insertion instrument 300 isillustrated as elongate along a longitudinal axis 302 that extendssubstantially along a longitudinal direction L, and defines a proximalend 304 and an opposed distal end 306 that is spaced from the proximalend 304 along the longitudinal axis 302. Thus, it should be appreciatedthat the terms “distal” and “proximal” and derivatives thereof refer toa spatial orientation closer to the distal end 306 and the proximal end304, respectively. Furthermore, the directional term “downstream” and“upstream” and derivatives thereof refer to a direction that extendsfrom the proximal end 304 toward the distal end 306, and a directionthat extends from the distal end 306 toward the proximal end 304,respectively. The insertion instrument 300 further extends along alateral direction A that is substantially perpendicular to thelongitudinal direction L, and a transverse direction T that issubstantially perpendicular to the longitudinal direction L and thelateral direction A. It can also be said that the lateral and transversedirections A and T extend radially with respect to the longitudinal axis302. Thus, the terms “radially outward” and “radially inward” andderivatives thereof refer to a direction away from and toward thelongitudinal axis 302, respectively, and can be used synonymously withlaterally and transversely as desired.

The insertion instrument 300 includes a casing 308 that can provide ahandle, and a cannula 310 that is supported by the casing 308 andextends distally out from the casing 308 along a central axis 309. Thecannula 310 can be fixed to the casing 308 with respect to translation.The central axis 309 can extend longitudinally and can thus be inlinewith the longitudinal axis 302 of the insertion instrument 300, or canbe offset with respect to the longitudinal axis 302 of the insertioninstrument 300. The cannula 310 extends substantially straight asillustrated, but can alternatively be curved or define any suitablealternative shape as desired. The cannula 310 defines an elongateopening 312, which can be elongate longitudinally or along any otherdirection or combination of directions as desired, that is sized toreceive the at least one anchor knot, such as the first and secondanchor knots 22 a and 22 b. The insertion instrument 300 can furtherinclude a biasing member such as a plug 314 that is disposed in theelongate opening 312, such that the first knot anchor body 28 a isdisposed in the cannula 310 at a location upstream of the plug 314, andthe second knot anchor 28 b is disposed in the cannula 310 at a locationdownstream of the plug 314. Thus, the plug 314 can further provide adivider that separates the first anchor body 28 a from the second anchorbody 28 b along the longitudinal direction. The first and second anchorbodies 28 a and 28 b are stacked in the instrument 300 along thelongitudinal axis 302. The cannula 310 defines a distal tip 311 that isconfigured to pierce tissue at a target location so as to deliver atleast one anchor to the target location.

The insertion instrument 300 further includes a plunger 316 that issupported by the casing 308, and extends proximally out from the casing308. The plunger 316 is configured to translate distally from an initialor first position illustrated in FIGS. 7A-D along a first stroke to asecond position illustrated in FIGS. 8A-D, thereby causing the plug 314to bias the second anchor 22 b distally so as to eject the second anchor22 b out the cannula 310, for instance out a distal ejection port 442that extends substantially longitudinally through the tip 311.

Once the second anchor 22 b has been ejected out the ejection port 442,the plunger 316 is configured to translate further distally along afirst portion of a second stroke illustrated in FIGS. 11A-C, and along asecond portion of the second stroke illustrated in FIGS. 12A-C, suchthat a push rod 330 (see FIG. 7C) biases the first anchor body 28 adistally so as to eject the first anchor 22 a out the cannula 310, forinstance out the ejection port 442, into the first target anatomicallocation 22 a. Alternatively, as described in more detail below, thecannula 310 can define a side ejection port 318 (described below withreference to FIG. 31) that is configured to eject the first and secondanchor bodies 28 a and 28 b out the cannula 310 along a directionangularly offset with respect to the central axis 309.

The insertion instrument 300 can be configured such that the plunger 316moves distally from the second position to an offset position asillustrated in FIGS. 9A-D before moving along an intermediate strokefrom the offset position to an intermediate position as illustrated inFIGS. 10A-D. Accordingly, the plunger 316 can move from the secondposition, to the offset position, to the intermediate position, andfinally to the third position illustrated in FIGS. 12A-D. In accordancewith the illustrated embodiment, the plunger 316 is rotated from thesecond position to the intermediate position prior to translating alongthe second stroke to the third position. For instance, the plunger 316can move along a first portion of the second stroke as illustrated inFIGS. 11A-D prior to moving along a second portion of the second strokeas illustrated in FIGS. 12A-D. An actuation force can be applied to theactuation portion 131 a and 131 b of the first and second anchors 22 aand 22 b, respectively, after each anchor has been ejected, or canalternatively be applied after both anchors 22 a and 22 b have beenejected. The anchors 22 a and 22 b can be attached to each other in anymanner as desired, for instance across the gap 24 c.

Referring now to FIGS. 7A-C in particular, the casing 308 defines a body320 that defines at least one radially outer side wall 322, such as aplurality of joined walls that can be of any size and shape, and furtherdefines a proximal wall 324 and an opposed distal wall 326. The at leastone outer wall 322, the proximal wall 324, and the distal wall 326 atleast partially define an interior 328 that can be in fluidcommunication with the elongate opening 312 of the cannula 310. Thecannula 310 is attached to the distal wall 326 of the casing 308 and isthus fixed to the casing 308. The cannula 310 extends distally from thecasing 308 to the tip 311. The tip 311 can be tapered distally, suchthat the cannula 310 defines a tapered distal end. For instance, the tip311 can be conical, that is the tip 311 can define a portion that isconical, and can define the shape of a cone or any suitable alternativeshape as desired. The insertion instrument 300 can further include asupport sleeve 313 that at least partially surrounds the cannula 310 atthe interface with the casing 308, and extends distally along a portionof the length of the cannula 310. The support sleeve 313 providesstructural support and rigidity to the cannula 310.

The plunger 316 defines a distal end 316 a that is disposed in theinterior 328, a body portion 316 b that extends proximally from thedistal end 316 a and out the proximal wall 324 of the casing 308, and aproximal end 316 c that can define a grip that is disposed outside thecasing 308. The insertion instrument 300 further includes a first pusherassembly 317 that can include the plunger 316 and a first pusher member,such as a push rod 330 that is attached, directly or indirectly, to thedistal end 316 a of the plunger 316. The push rod 330 can be attached tothe plunger 316 (for instance integral with the plunger 316 orseparately attached to the plunger 316 via any suitable fastener orintermediate apparatus as desired). For instance, in accordance with theillustrated embodiment, the distal end 316 a of the plunger is attachedto a retention housing 392 as is described in more detail below withreference to FIG. 17. The push rod 330 is attached to the retentionhousing 392, and is thus attached to the plunger 316. The push rod 330can extend distally from the plunger 316 into the opening 312 of thecannula 310 and out the distal wall 326 of the casing 308. It should beappreciated that reference to at least one or both of the plunger 316and the push rod 330 can be applicable to the first pusher assembly 317.For instance, description with respect to the structure that is fixed orcoupled to at least one or both of the plunger 316 and the push rod 330can be said to be fixed or coupled, respectively, to the first pusherassembly 317.

Because the push rod 330 is translatably fixed to the plunger 316,movement of the plunger 316 proximally and distally causes the push rod330 to likewise move proximally and distally. The push rod 330 defines adistal end 330 a disposed in the opening 312 of the cannula 310.Accordingly, the distal end 330 a of the push rod 330 is configured tobrace against the first anchor 22 a when the insertion instrument 300 isin the first position as illustrated in FIGS. 7A-D. The distal end 330 aof the push rod 330 is configured to brace against the first anchor 22 awhen the insertion instrument 300 is in the first position, and also asthe plunger 316, and thus the push rod 330, translates distally from thefirst position to the second position, such that the push rod 330 ejectsthe first anchor 22 a out the insertion instrument 300 and into therespective target location 24 a. When a tensile force is applied to therespective actuation member 37 a substantially along the direction ofelongation of the anchor body 28 a after the first anchor body 28 a hasbeen ejected and is braced against the anatomical structure 24, theanchor body 28 a expands along the second direction 35 that isperpendicular with respect to the direction of elongation 34 of theanchor body 28 a (see, for instance, FIGS. 1A-B).

The insertion instrument 300 can further includes a second pusherassembly 333 that includes an attachment member 331, such as a collar332 that extends about the plunger 316 and can at least partiallysurround the plunger 316, and a second pusher member, such as a pushtube 334 that extends distally from the collar 332 and at leastpartially surrounds the push rod 330. The push tube 334 can be attachedto the collar 332 (for instance integral with the collar 332 orseparately attached to the collar 332 via any suitable fastener asdesired). Accordingly, description of at least one or both of the pushtube and the collar 332 can be applicable to the second pusher assembly333. For instance, description with respect to the structure that isfixed or coupled to at least one or both of the push tube 334 and thecollar 332 can be said to be fixed or coupled, respectively, to thesecond pusher assembly 333.

The push tube 334 can include the plug 314 that can define the distalend of the push tube 334. The push tube 334 can be cannulated inaccordance with the illustrated embodiment so as to define alongitudinally elongate opening 335, and the push rod 330 has an outerdiameter that is less than that of the opening 335, such that the pushrod 330 is disposed inside the elongate opening 335 of the push tube334. It should be appreciated that structures described herein asdefining a diameter can alternatively define any suitably configuredcross section, which can be circular or alternatively shaped, and thuscan define any cross-sectional dimension which can be a diameter or not.The cannula 310 can contain both the first and second anchor bodies 28 aand 28 b. For instance, the push tube 334 can contain the first anchorbody 28 a at a location upstream of the plug 314, and the cannula 310can contain the second anchor body 28 b at a location distal to the plug314, and thus distal to the first anchor body 28 a.

The insertion instrument 300 can include a force transfer member 336that can extend radially inward from the distal end of the collar 332,such that the push rod 330 extends distally through or from forcetransfer member 336. The force transfer member 336 can abut the collar332, or can be fixed to the distal end of the collar 332. The forcetransfer member 336 can further abut or be fixed to the proximal end ofthe push tube 334. If the force transfer member 336 abuts one or both ofthe collar 332 and the push tube 334, then 1) distal movement of thecollar 332 biases the force transfer member 336 distally, which in turnbiases the push tube 334, including the plug 314, distally, and 2)proximal movement of the collar 332 does not bias the push tube 334proximally. If the force transfer member 336 is attached to the collar332 and the push tube 334, then 1) distal movement of the collar 332biases the force transfer member 336 distally, which in turn biases thepush tube 334, including the plug 314, distally, and 2) proximalmovement of the collar 332 biases the force transfer member 336distally, which in turn biases the push tube 334, including the plug314, distally. Whether the force transfer member 336 abuts or is fixedto the collar 332 and the push tube 334, it can be said that the collar332 is translatably coupled to the push tube 334, such that distaltranslation of the collar 332 causes the push tube 334 to translatedistally.

The collar 332, and thus the push tube 334, including the plug 314, isconfigured to be selectively coupled to and decoupled from the firstpusher assembly 317 with respect to translation, and configured to beselectively coupled to and decoupled from the casing 308 with respect totranslation. For instance, in a first configuration, the collar 332 istranslatably fixed to the plunger 316, and thus also to the push rod330. Furthermore, in the first configuration, the collar 332 istranslatably decoupled from the casing 308 and thus also translatablydecoupled from the cannula 310. Accordingly, in the first configuration,proximal and distal movement of the plunger 316 and push rod 330relative to the casing 308 and cannula 310 causes the collar 332 tocorrespondingly move proximally and distally relative to the casing 308and cannula 310. It should be appreciated that in the firstconfiguration, the push rod 330 is translatably coupled to the push tube334, such that the push rod 330 and the push tube 334 translate intandem, for instance during the first stroke, thereby causing the pushtube 334 to eject the second anchor body 28 b out the cannula 310, aswill be described in more detail below. As described above, when atensile force is applied to the respective actuation member 37 bsubstantially along the direction of elongation of the second anchorbody 28 b after the second anchor body 28 b has been ejected, the secondanchor body 28 b expands along the second direction 35 that isperpendicular with respect to the direction of elongation 34 of theanchor body 28 b (see, for instance, FIGS. 1A-B).

In a second configuration, the collar 332 is translatably decoupled fromthe plunger 316, and thus the push rod 330, and is translatably coupledto the casing 308, and thus the cannula 310. Accordingly, in the secondconfiguration, the plunger 316 and push rod 330 move proximally anddistally relative to the collar 332 and the casing 308 and the cannula310. It should be appreciated that in the second configuration, afterthe first stroke, the push rod 330 is translatably decoupled from thepush tube 334, such that the push rod 330 translates distally relativeto the push tube 334 and thus the plug 314, for instance during at leasta portion of the second stroke, thereby causing the push rod 330 toeject the first anchor body 28 a out the cannula 310, as will bedescribed in more detail below.

Referring now to FIGS. 13A-G, the insertion instrument 300 includes aguide system 329 that operably couples the casing 308 and the push tube334 so as to guide relative movement between the casing 308 and the pushrod 330. In accordance with the illustrated embodiment, the guide system329 includes complementary first and second guide members 338 and 340,respectively, that are coupled between the casing 308 and the collar332. In accordance with the illustrated embodiment, during the firststroke and a first portion of the second stroke, the first and secondguide members 338 and 340 cooperate to guide the movement of the plunger316 (and push rod 330) and collar 332 (and push tube 334) in tandemrelative to the casing 308. In that regard, it should be appreciatedthat the first and second guide members 338 and 340 are operably coupledbetween the plunger 316 and the collar 332 during the first stroke and afirst portion of the second stroke. In accordance with the illustratedembodiment, during a second portion of the second stroke, the first andsecond guide members 338 and 340 cooperate to guide the movement of theplunger 316 and push rod 330 relative to both the collar 332 (and pushtube 334) and the casing 308. In that regard, it should be appreciatedthat the first and second guide members 338 and 340 are operably coupledbetween the casing 308 and the collar 332 during the second portion ofthe second stroke.

In accordance with the illustrated embodiment, one of the first andsecond guide members 338 and 340 is provided as a guide track 342 thatextends into one of the collar 332 and the casing 308, and the other ofthe guide members 338 and 340 is provided as a guide pin 344 thatextends into the guide track 342, such that the guide pin 344 rides inthe guide track 342, thereby operably coupling the collar 332 to thecasing 308. In accordance with the illustrated embodiment, the firstguide member 338 is provided as the guide track 342 that is carried, anddefined, by the collar 332, and the second guide member 340 is providedas the guide pin 344 that is translatably fixed to the casing 308 andextends into the guide track 342. For instance, the guide pin 344extends radially into or through the side wall 322 of the casing 308 andinto the guide track 342. It should be appreciated in accordance with analternative embodiment that the guide track 342 can be carried, anddefined, by the casing 308 and the guide pin 344 can be translatablyfixed to the collar 332.

In accordance with the embodiment illustrated in FIG. 13G, the track 342defines a slot 339 that extends radially into the collar 332 but notthrough the collar 332, and a base 341 of the collar 332 that is locatedat the radially inner end of the slot 339. The guide track 342 defines afirst guide portion such as a first track portion 342 a, a second guideportion such as a second track portion 342 b that is offset, forinstance radially, with respect to the first track portion 342 a, and anangled intermediate guide portion such as an angled intermediate trackportion 342 c that connects the first track portion 342 a to the secondtrack portion 342 a. Accordingly, the guide pin 344 is configured totravel along the first track portion 342 a during the first stroke asthe plunger 316 is translated from the first position to the secondposition. In particular, the second track portion 342 a defines a firstor distal end 342 a′ an opposed second or proximal end 342 a″, and anoffset position 342 a′″ between the distal end 342 a and the proximalend 342 a″. The offset position 342 a′″ is aligned with an intermediatetrack portion 342 c that extends between the first track portion 342 aand the second track portion 342 b. Once the guide pin 344 hastranslated from the proximal end 342 a″ to the offset position 342 a′″,the guide pin 344 can travel along the intermediate track portion 342 ctoward the second track portion 342 b as the plunger 316 is rotated tothe intermediate position. The guide pin 344 can subsequently traveldistally along the second track portion 342 b as the plunger 316 isfurther translated toward the third position.

The first and second guide track portions 342 a and 342 b extendsubstantially longitudinally, such that distal translation of the collar332 relative to the casing 308 during the first stroke causes the guidepin 344 and the guide track 342 to translate relative to each other. Inaccordance with the illustrated embodiment as shown in FIGS. 13A-B, theguide track 342 translates distally with respect to the guide pin 344,thereby causing the guide pin 344 to translate proximally along thefirst guide track portion 342 a during the first stroke of the plunger316 and the collar 332. Once the first stroke is completed, and thesecond anchor body 28 b has been ejected from the cannula 310, the guidepin 344 is disposed at the proximal end 342 a″ of the first trackportion 342 a. The collar 332 defines a stop member at the proximal endof the first track portion 342 a. Thus, the guide pin 344 interfereswith the collar 332, thereby preventing the plunger 316 and collar 332from further translating distally relative to the casing 308.Accordingly, the user is prevented from inadvertently ejecting the firstanchor body 308 a by continued distal translation of the plunger 316after the second anchor body 28 b has been ejected.

It should be appreciated during the first stroke that the guide pin 344translates from the distal position 342 a′ (illustrated in FIG. 13A),past the offset position 342 a′″ (illustrated in FIG. 13C), to theproximal end 342 a″ (illustrated in FIG. 13B). When the guide pin 344 isat the offset position 342 a′″, the push tube 344 is slightly recessedproximally with respect to the distal ejection port 442 (see FIG. 9D).As the guide pin 344 moves to the proximal end 342 a″, the push tube 344translates distally with respect to the ejection port 442 (see FIG. 8D).As further illustrated in FIGS. 8A and 9A, the insertion instrument 300includes a spring member 365, which can be a coil spring, that extendsbetween a spring seat 381 that is secured to the casing 308, forinstance at the distal wall 326 of the casing 308, and the forcetransfer member 336. Thus, the spring member 365 is operably coupledbetween the casing 308 and the second pusher assembly 333. When thesecond pusher assembly 333 is coupled to the first pusher assembly 317with respect to translation, the spring member 365 is operably coupledbetween the casing 308 and the first pusher assembly 317.

The spring member 365 provides a force that biases the collar 332, andthus the plunger 316, proximally as the plunger 316 translates distallyalong the first stroke. Accordingly, referring to FIGS. 13B-C, once theguide pin 344 is in the second position at the proximal end 342 a″ ofthe first track portion 342 a, the spring force biases the collar 332 tomove such that the guide pin 344 translates distally from the proximalend 342 a″ of the first track portion 342 a toward the distal end 342 a′of the first track portion 342 a. However, as is described in moredetail below, the track 342 includes a base 341 that interferes withmovement of the guide pin 344 along a distal direction from the offsetposition 342 a′″. When the guide pin 344 is in the offset position 342a′″, the plug 314 of the push tube 334 is recessed proximally withrespect to, or substantially aligned with, the distal ejection port 442(see FIG. 9D) such that the plug 314 does not extend distally beyond thedistal ejection port 442.

Referring now to FIGS. 13C-D, the plunger 316 can be rotated along thedirection of Arrow A as it travels along the intermediate stroke. Theinsertion instrument 300 defines a key 318 that rotatably couples theplunger 316 and the collar 332. In accordance with the illustratedembodiment, the key 318 is provided as complementary flat surfaces ofthe plunger 316 and the collar 332 that prevents defines the plunger 316from rotating with respect to the collar 332. As a result, rotation ofthe plunger 316 along the direction of Arrow A causes the collar 332 tolikewise rotate along the direction of Arrow A. Accordingly, uponcompletion of the first stroke, rotation of the plunger 316 causes theguide pin 344 to travel along the intermediate stroke from the firsttrack portion 342 a, along intermediate track portion 342 c, and to thedistal end of the second track portion 342 b. Referring now to FIGS.13D-E, once the guide pin 344 is disposed in the second track portion342 b, further translation of the plunger 316 and the collar 332 along afirst portion of the second stroke causes the guide pin 344 to translatedistally relative to the casing 308 until the guide pin 344 has traveledto the proximal end of the second track portion 342 b. The collar 332defines a stop member at the proximal end of the second track portion342 b that prevents the collar 332 from continuing to move distally withrespect to the casing 308. It can be said that the collar 332 defines astop member at the terminal ends of the first and second track portions342 a and 342 b.

Referring now to FIGS. 13E-F, and as is described in more detail below,once the guide pin 344 has traveled to the proximal end of the secondtrack portion 342 b, further distal translation of the plunger 316 alonga second portion of the second stroke is decoupled from the collar 332,such that the plunger 316 and push rod 330 translate relative to thecollar 332, the push tube 334, and the casing 308. The plunger 316 isconfigured to translate distally relative to the collar 332 and casing308 during the second portion of the second stroke until the distal end316 c of the plunger abuts the casing 308, for instance at the proximalwall 324, thereby completing the second stroke and ejecting the secondanchor body 28 b out the cannula, as illustrated in FIGS. 12A-C.

Referring now to FIG. 13G in particular, the base 341 of the track 342defines a first base portion 341 a at the first track portion 342 a, asecond base portion 341 b at the second track portion 342 b, and anintermediate base portion 341 c at the intermediate track portion 342 c.The base 341 has portions that are deeper than others such that as theguide pin 344 rides along the track, at least one or both of audible andtactile feedback can be detected by the user to indicate that the collar332, and in some instances the plunger 316, have completed a stroke or aportion of a stroke. The base 341 can further provide a stop thatprevents the guide pin 344 from moving proximally along portions of thetrack 342. For instance, the first base portion 341 a defines a first ordistal first base portion 341 a′ and a second or proximal first baseportion 341 a″ that is deeper than the distal first base portion 341 a′.The first base portion 341 a defines an edge 346 a that is disposedbetween the proximal first base portion 341 a′ and the distal first baseportion 341 a″. The edge 346 a can extend radially, or along a directionhaving a radial component that extends toward the longitudinal axis 302.

The guide pin 344 can define a post 344 a and a spring member 345 thatis connected between the casing 308 and the post 344 a, and biases thepost 344 a into the track 342 and against the base 341. Thus, as theguide pin 344 moves proximally relative to the first track portion 342 awhen the collar 332 and the plunger 316 move along the first stroke, thedistal portion 344 b of the guide pin 344 moves along the distal firstbase portion 341 a′ and over the edge 346 a as the guide pin 344 travelsto the distal first base portion 341 a″. As the guide pin 344 travelsover the edge 346 a and is biased against the track 341 by a springforce of the spring member 345, at least one of a tactile and an audiblefeedback can be communicated to the user that the plunger 316 and thecollar 332 have completed the first stroke. The edge 346 a can bedisposed at the offset position 342 a′″ of the first track portion, suchthat once the guide pin 344 has traveled along the first base portion341 a to the proximal end 342 a″ of the first track portion 342 a, theedge 346 a prevents the force of the spring member 365 from causing theguide pin 344 to translate proximal with respect to the offset position342 a′″ of the first track portion 342 a. Rather, because the guide pin344 abuts the edge 346 a, the biasing force of the spring member 365brings the guide pin 344 into alignment with the intermediate trackportion 342 c, and in position to be moved or rotated along theintermediate stroke.

With continuing reference to FIG. 13G, the intermediate base portion 341c defines a first or proximal intermediate base portion 341 c′ and asecond or distal intermediate base portion 341 c″ that is deeper thanthe proximal intermediate base portion 341 c′. The distal intermediatebase portion 341 c″ can be aligned with the second base portion 341 b.The intermediate base portion 341 c defines an edge 346 c that isdisposed between the proximal intermediate base portion 341 a′ and thedistal intermediate base portion 341 a″. Alternatively, the intermediatebase portion 341 c can be devoid of the distal portion, such that theedge 346 c is disposed between the intermediate base portion 341 c andthe second base portion 341 b. The edge 346 c can extend radially, oralong a direction having a radial component that extends toward thelongitudinal axis 302. As the distal portion 344 b of the guide pin 344travels over the edge 346 c during a transition between the intermediatestroke and the second stroke, and is aligned with the second trackportion 342 b, at least one of a tactile and an audible feedback can becommunicated to the user that the plunger 316 and the collar 332 havecompleted the intermediate stroke, and are in position to be moved alongthe first portion of the second stroke. Furthermore, the edge 346 cprevents the plunger 316 from being rotated along a direction oppositethe direction of Arrow A (FIG. 13C) once the guide pin 344 is positionedin the second track portion 342 b.

The second base portion 341 b defines a first or proximal second baseportion 341 b′ and a second or distal second base portion 341 b″ that isdeeper than the proximal second base portion 341 b′. The distal secondbase portion 341 b″ can be disposed at the terminal distal end of thesecond track portion 342 b. The second base portion 341 b defines anedge 346 b that is disposed between the proximal second base portion 341b′ and the distal second base portion 341 b″. The edge 346 b can extendradially, or along a direction having a radial component that extendstoward the longitudinal axis 302. As the distal portion 344 b of theguide pin 344 travels over the edge 346 b, at least one of a tactile andan audible feedback can be communicated to the user that the plunger 316and the collar 332 have completed the first portion of the secondstroke. The feedback can indicate that the plunger 316 is decoupled fromthe collar 332, and can translate along the second portion of the secondstroke independent of the collar 332, as will now be described.Furthermore, the edge 346 b prevents the guide pin 344 from movingproximally along the second track portion 342 b once the plunger 316 andthe collar 332 have been decoupled.

Referring now to FIG. 7C and FIGS. 14A-D, the insertion instrument 300includes a coupling assembly 350 that is configured to iterate between afirst mode of operation and a second mode of operation. In the firstmode of operation, the coupling assembly 350 translatably fixes thefirst pusher member, illustrated as the push rod 330, and the secondpusher member, illustrated as the push tube 334 with respect totranslation during the first stroke. In the first mode of operation, thecoupling assembly 350 releasably translatably fixes the push rod 330 tothe push tube 334, such that in a second mode of operation, the couplingassembly 350 decouples the push rod 330 from the push tube 334 such thatthe push rod 330 can translate distally relative to the push tube 334after the first stroke, for instance during the second stroke.Furthermore, in the second mode of operation, the coupling assembly 350can translatably fix the push tube 334 to the casing 308, such that adistal translation force applied to the plunger 316 causes the plunger316, and thus the push rod 330, to translate distally relative to thepush tube 334, and thus the collar 332. In accordance with theillustrated embodiment, the coupling assembly 350 is in the first modeof operation during the first stroke of the first pusher assembly 317,the intermediate stroke of the first pusher assembly 317, and the firstportion of the second stroke of the first pusher assembly 317. Inaccordance with the illustrated embodiment, the coupling assembly 350transitions to the second mode of operation, as the first pusherassembly 317 transitions between the first portion of the second strokeand the second portion of the second stroke. In accordance with theillustrated embodiment, the coupling assembly 350 is in the second modeof operation when the first pusher assembly 317 translates along thesecond portion of the second stroke and the second portion of the secondstroke.

The coupling assembly 350 can include at least one first coupling member352 illustrated as a first recess 354 that extends radially into thefirst pusher assembly 317, such as the plunger 316, in accordance withthe illustrated embodiment. The coupling assembly 350 can furtherinclude at least one second coupling member 356 illustrated as a channel358, that extends radially through the second pusher assembly 333, suchas the collar 332, in accordance with the illustrated embodiment. Thecoupling assembly 350 can further include at least one third couplingmember 360 illustrated as a second recess 362 that is carried by thecasing 308. For instance, the insertion instrument 300 can include aninner housing 325 that is carried by the casing 308, for instance by theproximal wall 324 of the casing 308. The second recess 362 extendsradially outward into the inner housing 325 in accordance with theillustrated embodiment. Alternatively, the second recess 362 couldextend radially outward into the casing 308.

Furthermore, in accordance with the illustrated embodiment, the secondrecess 362 is disposed distal with respect to the channel 358 when theplunger 316 is in the first position illustrated in FIGS. 7C and 14B.The second recess 362 can further be radially offset with respect to thechannel 358 when the plunger 316 is in the first position illustrated inFIGS. 7A and 13A. Alternatively, the second recess 362 can be radiallyaligned with respect to the second recess 362 (for instance if the track342 does not include the intermediate track portion 342 c, and canalternatively still be annular so as to circumscribe the radially innersurface of the casing 308 if desired.

The coupling assembly 350 can further include at least one fourthcoupling member 368 illustrated as a latch 370 that is sized topartially fit in each of the first recess 354, the second recess 362. Inaccordance with the illustrated embodiment, the latch 370 is carried bythe collar 332, and is configured as a leaf spring 371 that is disposedin the channel 358, which can be provided as a substantially U-shapedaperture or cut-out of the collar 332 so as to define the leaf spring371. The leaf spring 371 carries a radially inward projection 373 thatis sized to fit into the first recess of the plunger 316. The latch 370can be further sized to be disposed in the channel 358, and is flexibleradially inward and outward. Accordingly, the latch 370 can travel alongthe channel 358 between the first recess 354 (FIG. 14B) and the secondrecess 362 (FIG. 14D).

In accordance with the illustrated embodiment, the coupling assembly 350is in the first mode of operation when the guide pin 344 is in the firsttrack portion 342 a, and remains in the first mode of operation when theguide pin 344 travels from the first track portion 342 a to theintermediate track portion 342 c, and further remains in the first modeof operation when the guide pin 344 travels along part of the secondtrack portion 342 b. In particular, the first recess 354 and the channel358, and the projection 371 of the latch 370, can be positioned so as tobe radially aligned when the guide pin 344 extends into the any of, andall of as illustrated, the first track portion 342 a, the intermediatetrack portion 342 c, and the portion of the second track portion 342 b.

Accordingly, in the first mode of operation, the latch 370 is partiallydisposed in the first recess 354 of the plunger 316, and extends intothe channel 358 of the collar 332. The latch projection 373 can be sizedso as to be captured in the first recess 354, so as to couple theplunger 316 to the collar 332 with respect to translational movement. Asa result, when the latch 370 is coupled to the plunger 316, the plunger316 and the collar 332, and thus the first and second pusher assemblies317 and 333, are coupled with respect to movement or translation alongthe longitudinal direction.

Referring now to FIGS. 14C-D, because the second recess 362 is sized toreceive the latch 370 in accordance with the illustrated embodiment,when the latch 370 moves from the first recess 354 into the secondrecess 362, the latch 370 decouples the first pusher assembly 317 fromthe second pusher assembly 333, and couples the second pusher assembly333, and in particular the collar 332, to the casing 308 with respect toat least translation and can also couple the collar 332 to the casing308 with respect to rotation. As described above, the casing 308 isfixed to the cannula 310 with respect to at least translation, and canfurther be fixed to the cannula 310 with respect to translation. Inaccordance with the illustrated embodiment, when the plunger 316 isrotated from the second position to the intermediate position such thatthe guide pin 344 travels along the intermediate track portion 342 c(see FIGS. 13C-D), the first recess 354 and the channel 358 are broughtinto longitudinal alignment with the second recess 362.

During the first portion of the second stroke (see FIG. 13E), theplunger 316 and the collar 332 translate longitudinally until the firstrecess 354 and the channel 358 are aligned with the second recess 362 ofthe casing 308. During the transition between the first and secondportions of the second stroke (see also FIG. 13F), the latch 370 isdriven (for instance cams) out of the first recess 352 and thus movesfrom the first recess 352 into the second recess 362, as illustrated inFIGS. 14C-D. In accordance with an alternative embodiment, the plunger316 can include a spring member that biases the latch 370 radiallyoutward from the first recess 352 and into the second recess 362.Alternatively still, the insertion instrument 300 can be configured suchthat the latch 370 can cam out of the first recess 352 and move from thefirst recess into the second recess 362 the as the plunger 316 and thecollar 332 rotate past the second recess 362 of the casing 308. Once thelatch 370 has moved out of the first recess 354 and into the secondrecess 362 while remaining attached to the collar 332, the plunger 316can continue to translate distally relative to the collar 332 during thesecond portion of the second stroke (see FIG. 13F), which causes thepush rod 330 to translate distally relative to the push tube 334.

Operation of the insertion instrument 300 will now be described withinitial reference to FIGS. 7A-D, 13A, and FIGS. 14A-D. In particular,the insertion instrument 300 can be constructed such that when theplunger 316, and thus the push rod 330, is in the first position, thefirst and second anchor bodies 28 a and 28 b are disposed in the cannula310. In accordance with the illustrated embodiment, the first anchorbody 28 a is disposed longitudinally between the ejection port 442 andthe plug 314 of the push tube 334. When the first pusher assembly 317,including the plunger 316 and the push rod 330, and the second pusherassembly 333, including the collar 332 and the push tube 334, are in thefirst position, the coupling assembly releasably couples the firstpusher assembly 317 and the second pusher assembly 333 with respect tolongitudinal movement and rotational movement. In particular, the latch370 extends in both the first recess 354 and the channel 358, therebyreleasably coupling the plunger 316 and the collar 332 with respect tolongitudinal movement and rotational movement.

Referring now to FIGS. 8A-D, 13A-B, and 14B in particular, the tip 311can be injected into the anatomical structure 24, for instance at thesecond target anatomical location 24 b, until at least a portion (suchas a distal portion) of the ejection port 442 extends distal of, orbehind, the anatomical structure 24. In accordance with the illustratedembodiment, the insertion instrument can include a depth stop 383 thatextends radially out from the cannula 310, and is configured to abut theanatomical structure 24 and provides resistance to further insertion ofthe cannula 310 into the anatomical structure 24 once the cannula 310has been injected to a desired depth, for instance such that theejection port 442 is disposed behind the anatomical structure 24. Inthis regard, the depth stop 383 can provide tactile feedback to the userthat the cannula 310 has been injected into the target structure 24 atthe desired depth. When a distal force is applied to the plunger 316while the casing 308 remains stationary, for instance when a user gripsthe casing 308 relatively stationary while applying a distal force tothe plunger 316, the first and second pusher assemblies 317 and 333translate distally with respect to the casing 308 along the firststroke. As the first and second pusher assemblies 317 and 333 traveldistally relative to the casing 308, the guide pin 344 travelsproximally along the first track portion 342 a of the collar 332 untilthe guide pin 344 reaches the proximal end 342 a″ of the first trackportion 342 a. As the second pusher assembly 333 travels distally, theplug 314 biases the second anchor body 28 a to translate distally towardthe tip 311. Furthermore, because the first pusher assembly 317translates distally with the second pusher assembly 333 relative to thecasing 308, and thus also the cannula 310, the pusher rod 330 biases thefirst anchor body 28 b downstream toward the tip 311 during the firststroke.

Once the guide pin 344 has reached the proximal end 342 a″ of the firstguide track portion 342 a, the plug 314 has translated distal withrespect to the proximal end of the ejection port 442, and thus hasbiased the second anchor body 28 b out the ejection port 442 to alocation behind the anatomical structure 24, for instance at the secondtarget anatomical location 24 b (see FIG. 1A) along the direction ofArrow B. Thus, the first track portion 342 a has a longitudinal lengthsufficient such that movement of the guide pin 344 along the first trackportion 342 a causes the push tube 334 to eject the second anchor body28 b from the insertion instrument 300. Once the plunger 316 and thecollar 332 have completed the first stroke, the plug 314 can be spacedproximally from the tip 311. It should be appreciated that the collar332 defines a stop at the proximal end 342 a″ of the first track portion342 a that prevents further distal translation of the collar 332, andthus of the push tube 334 and the push rod 330, before the latch 370 iscoupled to the casing 308, as described above with respect to FIG. 14C.

Next, referring to FIGS. 9A-D, once the second anchor body 28 b has beenejected out the insertion instrument 300, the distal force can beremoved from the plunger 316, which causes the spring member 365 to biasthe second pusher assembly 333, for instance the collar 332, and thusalso the first pusher assembly 317, proximally until the guide pin 344is aligned with the offset position 342 a′″ of the first track portion342 a, as described above. Once the guide pin is in the offset position342 a′″, the guide pin 344 is aligned with the intermediate trackportion 342 c, and the plunger 316 can be rotated to the second trackportion 342 b.

At any time after completion of the first stroke and prior to ejectionof the first anchor body 28 a, the second anchor body 28 b can beactuated to the expanded configuration illustrated in FIG. 1B. Forinstance, referring to FIG. 9E, the second anchor body 28 b can beactuated by removing the insertion instrument from the target anatomy24. As illustrated at FIG. 9B, and as described in more detail belowwith respect to, the insertion instrument 300 includes a strandretention assembly 390 that retains, for instance releaseably retains,at least one tensioning strand 380 that is operably coupled to theactuation portions 131 a and 131 b of the first and second anchor bodies28 a and 28 b, extends proximally into the interior 328 of the casing308 and is releasably connected to the retention assembly 390. The atleast one tensioning strand 380 can be sized and positioned along theactuation strand 131 such that when tension is applied to the tensioningstrand 380, for instance when removing the insertion instrument 300proximally out of the anatomical structure 24, and in some embodimentstranslating the insertion instrument 310 further proximally afterremoval from the anatomical structure 24, the tensioning strand 380communicates the tension to the actuation strand 131 b, therebyactuating the second anchor body 28 b to its expanded configuration.Alternatively still, a user can manually apply the actuation force tothe respective actuation portion 131 b as desired. The insertioninstrument 300 can further define an elongate side slot 315 that extendsthrough one radial side of the cannula 310 at a location proximal withrespect to the ejection port 442. For instance, the slot 315 can extendfrom the ejection port 442 and proximally a sufficient distance andsized sufficiently such that the actuation portions 131 a-b andattachment portions 133 can extends through the slot 315 and attach tothe tensioning strand 380, which extends proximally into the casing 308.Alternatively, the at least one tensioning strand 380 can be attached tothe actuation portions 131 a-b inside the cannula 310, and can extendout the slot 315. Thus, the slot 315 can define a circumferential widththat is greater than the thickness of the actuation strands 38 a-b andthe at least one tensioning strand 380, but less than the thickness ofthe anchor bodies 28 a and 28 b when the anchor bodies 28 a and 28 b arein their respective first configurations inside the cannula 310.

Referring now to FIGS. 10A-D, 13C-D, and FIGS. 14A-D, once the secondanchor body 28 b has been ejected and the guide pin 344 is at the offsetposition 342 a′″ of the first track portion 342 a, and the insertioninstrument 300 has been removed from the anatomical structure 24, thetip 311 of the insertion instrument 300 can be injected into theanatomical structure 24 at the first target anatomical location 24 a inthe manner described above with respect to the second target anatomicallocation 24 b. The plunger 316 can be rotated along the direction ofArrow A before or after the tip 311 has been injected at the firsttarget anatomical location 24 a so as to travel along the intermediatestroke, which causes the guide pin 344 to translate along theintermediate track portion 342 c toward the second track portion 342 b.The plunger 316 can be rotated along the direction of Arrow A until theplunger 316 is in the intermediate position, whereby the guide pin 344is longitudinally aligned with the second track portion 342 b. Once theplunger 316 and collar 332 have rotated to the intermediate position,the plunger 316 and the collar 332 are again able to translate distallywith respect to the casing 308, and the latch 370 is longitudinallyaligned with the second recess 362.

Referring now to FIGS. 11A-D, 13D-E, and 14D, if the insertioninstrument 300 was not injected into the first target anatomicallocation 24 a prior to driving the plunger 316 to travel along theintermediate stroke, the insertion instrument 300 can be injected intothe first target anatomical location 24 a after driving the plunger 316to travel along the intermediate stroke, but before driving the plunger316 to translate along the second stroke. As the plunger 316 and thecollar 332 are further driven distally with respect to the casing 308,the first and second pusher assemblies 317 and 333 translate distallywith respect to the casing 308 along a first portion of the secondstroke. Translation of the plunger 316 along the first portion of thesecond stroke causes the guide pin 344 to translate proximally from theintermediate portion to a location between the proximal and distal endsof the second track portion 342 b.

As the plunger 316 translates distally with respect to the casing 308,the coupling assembly 350 causes the collar 332, and thus the push tube334 including the plug 314, to correspondingly translate distally withrespect to the casing 308 and cannula 310 until the first recess 354becomes radially aligned with the second recess 362. Thus, it can besaid that movement of the guide pin 344 along the second track portion342 b causes the latch 370 to move in alignment with the second recess362. The second recess 362 can be positioned such that the latch 370 isradially aligned with the second recess 362 once the plug 314 hastranslated to a position distal with respect to the tip 311, and thusdistal with respect to the ejection port 442, which can occur once theplunger 316 has translated along the first portion of the second stroke.Because the plug 314 has translated distal to the ejection port 442, theplug 314 is removed from interference with the first anchor body 28 a asthe first anchor body 28 a is ejected out the cannula 310. Furthermore,because the push rod 330 and the push tube 334 translate together alongthe first portion of the second stroke, the push rod 330 continues tobias the first anchor body 28 b downstream in the elongate opening 312of the cannula 310 toward the tip 311. As the first and second recesses354 and 362 become radially aligned at the transition between the firstand second portions of the second stroke, the latch 370 is driven fromthe first recess 354 into the second recess 362.

Referring now to FIGS. 12A-D, 13E-F, and 14D, once the latch 370 isdisposed in second recess 352, the second pusher assembly 333 becomescoupled to the casing 308 with respect to translation. Because the latch370 is removed from the first recess 354, the first pusher assembly 317is decoupled from the second pusher assembly 333 with respect totranslation. Accordingly, the first pusher assembly 317 can translatewith respect to the second pusher assembly 333 and the casing 308, andthus also with respect to the cannula 310. Thus, it can be said that thelatch 370 moves into the second recess 362 so as to translatablydecouple the push rod 330 and the push tube 334, such that the push rod330 is translatable independently of the push tube 344 so as to ejectthe first anchor body 28 a from the insertion instrument 330.

In accordance with the illustrated embodiment, as the first pusherassembly 317 is further biased distally with respect to the secondpusher assembly 333 during the second portion of the second stroke, theplunger 316 and the push rod 330 translate distally with respect to thecasing 308, and thus also the cannula 310. As a result, the push rod330, for instance at its distal end, biases the second anchor body 28 bto move distally relative to the plug 314. The plug 314 can define aramp 376 at its proximal end. The ramp 376 can thus be disposed distalof the ejection port 442 and positioned along the longitudinal axis 302,and thus aligned with the first anchor body 28 a as the pusher rod 330translates along the longitudinal direction and ejects the first anchorbody 28 a out the cannula 310 along the longitudinal direction. The ramp376 can define a tapered ejection surface 378 that is angled radiallyoutward as it extends distally. Accordingly, as the pusher rod 330biases the first anchor body 28 a to translate distally from theejection port 442 onto the ejection surface 378 as the pusher rod 330translates relative to the plug 314, the first anchor body 28 a ridesalong the ejection surface 378, which directs the first anchor body 28 aaway from the insertion instrument 300 at the first target anatomicallocation 24 a. Thus, the second track portion 342 b has a longitudinallength so as to allow the plug 314 to translate to a location distal ofthe tip 311, such that distal translation of the push rod 330 ejects thefirst anchor body 28 a out the insertion instrument.

While the coupling assembly 350 is configured such that the collar 332moves along the first stroke with the plunger 316, moves along theintermediate stroke with the plunger 316, and moves along a firstportion of the second stroke with the plunger 316, it should beappreciated in accordance with alternative embodiments that the couplingassembly 350 can be configured such that the collar 332 translatablydecouples from the plunger 316 after or during the first stroke, orafter or during the intermediate stroke.

Referring now to FIG. 12E, once the first anchor body 28 a has beeninjected to the first target location 24 a at a location behind theanatomical structure 24, the first anchor body 28 a can be actuated toits expanded configuration. For instance, the first anchor body 28 a canbe manually expanded by the user applying the actuation force F (FIG.1A) to the respective actuation portion 131 a. In accordance with theillustrated embodiment, the actuation strands 38 a and 38 b of the firstand second anchor bodies 28 a and 28 b, respectively, can be a commonstrand. Accordingly, the actuation portion 131 a is integral with theactuation portion 131 b, and proximal translation of the insertioninstrument 300, for instance upon removal of the insertion instrument300 from the anatomical structure 24, can cause the insertion instrument300 to apply a proximal tensile force onto the tensioning strand 380,which communicates the tensile force to the second anchor body 28 b,thereby actuating the second anchor body 28 to its expandedconfiguration.

Referring now to FIGS. 15A-E, the coupling assembly 350 can beconstructed in accordance with another embodiment, and can include atleast one first coupling member 352 illustrated as a first recess 354that extends radially into the first pusher assembly 317, such as theplunger 316, in accordance with the illustrated embodiment. The couplingassembly 350 can further include at least one second coupling member 356illustrated as a channel 358, that extends radially through the secondpusher assembly 333, such as the collar 332, in accordance with theillustrated embodiment. The coupling assembly 350 can further include atleast one third coupling member 360 illustrated as a second recess 362(FIG. 15C), that extends radially outward into the casing 308 inaccordance with the illustrated embodiment. Furthermore, in accordancewith the illustrated embodiment, the second recess 362 is disposeddistal with respect to the channel 358 when the plunger 316 is in thefirst position illustrated in FIGS. 7A and 13A. The second recess 362can further be radially offset with respect to the channel 358 when theplunger 316 is in the first position illustrated in FIGS. 7A and 13A.Alternatively, the second recess 362 can be radially aligned withrespect to the second recess 362 (for instance if the track 342 does notinclude the intermediate track portion 342 c, and can alternativelystill be annular so as to circumscribe the radially inner surface of thecasing 308 if desired.

The coupling assembly 350 can further include at least one fourthcoupling member 368 illustrated as a latch 370 that is sized topartially fit in each of the first recess 354, the second recess 362. Inaccordance with the illustrated embodiment, the latch 370 issubstantially spherical, and each of the first recess 354 and the secondrecess 362 can be substantially partially spherical, though it should beappreciated that the latch 370 and each of the first recess 354 and thesecond recess 362 can define any suitable shape as desired. The latch370 can be further sized to be disposed in the channel 358, which can bein the form of a slot that is defined by a longitudinal dimensionsubstantially equal to that of the latch 370, and is further defined bya radial dimension that is substantially equal to that of the latch 370.Accordingly, the latch 370 can travel along the channel 358 between thefirst recess 354 (FIGS. 15A-B) and the second recess 362 (FIGS. 15D-E).

In accordance with the illustrated embodiment, the coupling assembly 350is in the first mode of operation when the guide pin 344 is in the firsttrack portion 342 a, and remains in the first mode of operation when theguide pin 344 travels from the first track portion 342 a to theintermediate track portion 342 c, and further remains in the first modeof operation when the guide pin 344 travels along part of the secondtrack portion 342 b. In particular, the first recess 354 and the channel358 can be positioned so as to be radially aligned when the guide pin344 extends into the any of, and all of as illustrated, the first trackportion 342 a, the intermediate track portion 342 c, and the portion ofthe second track portion 342 b. Further, the latch 370 defines a radialdimension substantially equal to that of the first recess 354 and thechannel 358 combined, which is substantially equal to that of thechannel 358 and the second recess 362, combined. Thus, the radialdimension of the latch 370 is also substantially equal to that of thechannel 358 and the second recess 362 combined. It should also thereforebe appreciated that the first recess 354 and the second recess 362 candefine substantially the same radial dimension.

Accordingly, in the first mode of operation, the latch 370 is partiallydisposed in the first recess 354 of the plunger 316, and extends intothe channel 358 of the collar 332. The latch 370 can be sized so as tobe captured between the casing 308 and the plunger 316, and to extendthrough the collar 332 in the channel 358. Because the first recess 354is shaped substantially equal to a portion of the latch 370 in thelongitudinal and circumferential directions, longitudinal and rotationalmotion of the plunger 316 correspondingly causes the latch 370 to movelongitudinally and rotationally, respectively, along with the plunger316 when the latch 370 is disposed in the first recess 354. Furthermore,because the channel 358 is dimensioned substantially equal to that ofthe latch 370 in both the longitudinal and circumferential directions,longitudinal and rotational motion of the latch 370 correspondinglycauses the collar 332 to move longitudinally and rotationally,respectively. As a result, when the latch 370 is disposed in the firstrecess 354 and the channel 358, the plunger 316 and the collar 332, andthus the first and second pusher assemblies 317 and 333, are coupledwith respect to movement or translation along the longitudinaldirection, and are further coupled with respect to rotation or movementin the radial direction.

Referring now to FIGS. 15C-E, because the second recess 362 is shapedsubstantially equal to a portion of the latch 370 in accordance with theillustrated embodiment, when the latch 370 moves from the first recess354 into the second recess 362, the latch 370 decouples the first pusherassembly 317 from the second pusher assembly 333, and couples the secondpusher assembly 333, and in particular the collar 332, to the casing 308with respect to at least translation and can also couple the collar 332to the casing 308 with respect to rotation. As described above, thecasing 308 is fixed to the cannula 310 with respect to at leasttranslation, and can further be fixed to the cannula 310 with respect totranslation. In accordance with the illustrated embodiment, when theplunger 316 is rotated from the second position to the intermediateposition such that the guide pin 344 travels along the intermediatetrack portion 342 c (see FIGS. 13C-D), the first recess 354 and thechannel 358 are brought into longitudinal alignment with the secondrecess 362.

During the first portion of the second stroke (see FIG. 13E), theplunger 316 and the collar 332 translate longitudinally until the firstrecess 354 and the channel 358 are aligned with the second recess 362 ofthe casing 308. During the transition between the first and secondportions of the second stroke (see also FIG. 13F), the latch 370 isdriven (for instance cams) out of the first recess 352 and thus movesfrom the first recess 352 into the second recess 362. In accordance withan alternative embodiment, the plunger 316 can include a spring memberthat biases the latch 370 radially outward from the first recess 352 andinto the second recess 362. Alternatively still, the insertioninstrument 300 can be configured such that the latch 370 can cam out ofthe first recess 352 and move from the first recess into the secondrecess 362 the as the plunger 316 and the collar 332 translate past thesecond recess 362 of the casing 308. Once the latch 370 has moved out ofthe first recess 354 and into the second recess 362 while remainingdisposed in the channel 358 of the collar 332, the plunger 316 cancontinue to translate distally relative to the collar 332 during thesecond portion of the second stroke (see FIG. 13F), which causes thepush rod 330 to translate distally relative to the push tube 334.

Referring now to FIGS. 16A-17D, the anchor assembly 20 can include atleast one tensioning member, such as a tensioning strand 380 that can bestitched through the first and second actuation strands 38 a and 38 b,respectively, of the first and second anchor bodies 28 a and 28 b. Theanchor assembly 20 can include as many tensioning strands as desiredthat extend through one or both of the first and second actuationstrands 38 a and 38 b. The tensioning strand 380 defines a first end380′, a second end 380″, and a middle portion 380′″ that extends betweenthe first and second ends 380′ and 380″.

The tensioning strand 380 can be stitched through the first actuationstrand of at least one of the anchor bodies 28 a and 28 b. In accordancewith the illustrated embodiment, the tensioning strand 380 is stitchedthrough the first actuation strand, and in particular through the firstactuation portion 131 a and the first attachment portion 133 a of thefirst anchor body 28 a. For instance, the first tensioning stand 380 acan be threaded onto a needle, which is driven through the firstactuation strand 38 a, so as to insert the tensioning strand 380 throughthe actuation strand 38 a, such that the tensioning strand 380 isconnected to the actuation strand 38 a at a location closer to the firstanchor body 28 a than the second anchor body 28 b.

Referring now to FIGS. 7C and 17A-D the insertion instrument 300 caninclude a retention assembly, such as a strand retention assembly 390,that is configured to retain the at least one tensioning strand 380, andin particular the first and second ends 380 a′ and 380″ of thetensioning strand 380. In accordance with one embodiment, the retentionassembly releasably retains the tensioning strands 380. As will now bedescribed, the retention assembly 390 is translatably fixed to the firstpusher assembly 317, and thus moves proximally and distally along thelongitudinal direction L along with the plunger 316. Accordingly, thetensioning strand 308 provides sufficient slack for the implantation ofthe first and second anchor bodies 28 a and 28 b in the respectivetarget anatomical locations 24 a and 24 b. After the second anchor body28 b has been ejected from the cannula 310, proximal movement of theinsertion instrument 300, for instance when removing the instrument fromthe anatomical structure 24, causes the retention assembly 390 to movein the proximal direction, thereby applying the tensile actuation forceto the second tensioning strand 380, which communicates the actuationforce to the second actuation portion 131 b of the second actuationstrand 38 b, and causes the second anchor body 28 b to expand.Similarly, after the first anchor body 28 a has been ejected from thecannula 310, proximal movement of the insertion instrument 300, forinstance when removing the instrument from the anatomical structure 24,causes the retention assembly 390 to move in the proximal direction,thereby applying the tensile actuation force to the tensioning strand380, which communicates the actuation force to the first actuationportion 131 a of the first actuation strand 38 a, and causes the firstanchor body 28 a to expand.

The retention assembly 390 includes a retention housing 392 having ahousing body 394 that is supported, directly or indirectly, by theplunger 316 is coupled to the distal end 316 a of the plunger 316 inaccordance with the illustrated embodiment. The housing body 394 isfurther coupled to the push rod 330, which extends distally from theretention assembly 390. The retention housing 392 includes a firstlocking member 400 and a second locking member 402 that extend fromopposite, for instance laterally opposite, ends of the housing body 394.The first and second locking members 400 and 402 are configured toretain the respective first and second opposed ends 380′ and 380″ of thetensioning strand 380. The first locking member 400 is configured to bedisengaged so as to release the first end 380′. The second lockingmember 402 is configured to retain the second end 380″ of the tensioningstrand 380 when the first locking member 400 is released.

In accordance with the illustrated embodiment, the first locking member400 includes a locking body 407, and a clip 409 that is configured to beremovably secured to the locking body 407. For instance, the clip 409can be hingeably attached to the locking body 407, or otherwise movablyattached to the locking body 407 as desired. The retention housing 392can define a retention channel 411 disposed between the locking body 407and the clip 409. The retention channel 411 can have any suitable shapeas desired, and defines a serpentine shape in accordance with theillustrated embodiment. When the clip 409 is secured to the locking body407, the retention channel 411 has a thickness less than that of thefirst end 380′ of the tensioning strand 380. The clip 409 includes anoutwardly projecting release tab 413 that is configured to receive arelease force so as to release the clip 409 from the locking body 407,thereby freeing the first end 380′ of the retention strand 380 from theretention assembly 39, as is described in more detail below.

In accordance with the illustrated embodiment, the second locking member402 includes a second locking body 415, and a second clip 417 that isconfigured to be secured to the second locking body 415. The retentionhousing 392 can define a second retention channel 419 disposed betweenthe second locking body 415 and the second clip 417. The secondretention channel 419 can have any suitable shape as desired, anddefines a serpentine shape in accordance with the illustratedembodiment. When the second clip 417 is secured to the second lockingbody 415, the second retention channel 419 has a thickness less thanthat of the second end 380″ of the tensioning strand 380.

Thus, during operation, the first end 380′ of the tensioning strand 380can extend through the first retention channel 411 and the clip 409 canbe secured to the locking body 407, thereby releasably locking the firstend 380′ of the tensioning strand 380 in the first locking member 400.Similarly, the second end 380″ of the tensioning strand 380 can extendthrough the second retention channel 419 and the second clip 417 can besecured to the second locking body 415, thereby releasably locking thesecond end 380″ of the tensioning strand 380 in the second lockingmember 402. When the first and second ends 380′ and 380″ are secured tothe retention assembly, the insertion instrument can translateproximally once the first and second anchors 28 a and 28 b have beenimplanted to thereby deliver the tensile actuation force to thetensioning strand 380, which communicates the tensile actuation force tothe respective actuation portions of the anchor bodies, thereby causingthe anchor bodies to expand in the manner described above.

The retention assembly 490 further includes an actuator assembly 421that is configured to release the first locking member 400. Inparticular, the actuator assembly 421 can include an actuator or button423 that is carried by the casing 308 (see FIG. 7C), and at least onebiasing member, such as a pair of arms 425 that extend into the interior328 of the casing 308 from the button 423. It is recognized that thefirst anchor body 28 a is ejected from the instrument 300 once theplunger 316 has completed the second stroke. Accordingly, the actuatorassembly 421 is positioned such that the arms contact the retentionhousing 492 once the plunger 316 has reached the end of the secondstroke.

Referring to FIGS. 12C and 17C, As the plunger 316 reaches the end ofthe second stroke, the arms 425 ride along outer surfaces of the firstand second locking bodies 407 and 415, respectively, which causes thebutton 423 to raise radially outwardly from an unloaded position to aloaded position. Once the plunger 316 has reached the end of the secondstroke, one of the arms is aligned with the release tab 413.Accordingly, the button 423 can be depressed, which causes one of thearms 425 to drive the release tab 413 away from the first locking body407, which causes the clip 409 to move into an unlocked position wherebythe clip 409 is removed from the locking body 407 a sufficient amountsuch that the retention channel 411 is thicker than the first end 380′of the tensioning strand 380. As a result, the first end 380′ becomesunlocked from the retention assembly 390, and the instrument can bemoved proximally so as to draw the tensioning strand 380 through theactuation strands of the anchor bodies.

Referring now to FIG. 18A, the anchor assembly 20 can alternativelyinclude a pair of tensioning members, such as a first tensioning strand380 a and a second tensioning strand 380 b that can be stitched throughthe first and second actuation strands 38 a and 38 b, respectively, ofthe first and second anchor bodies 28 a and 28 b. The anchor assembly 20can include as many tensioning strands as desired that extend throughone or both of the first and second actuation strands 38 a and 38 b. Thefirst tensioning strand 380 a defines a first end 380 a′, a second end380 a″, and a middle portion 380 a′″ that extends between the first andsecond ends 380 a′ and 380 a″. Similarly, the second tensioning strand380 b defines a first end 380 b′, a second end 380 b″, and a middleportion 380 b′″ that extends between the first and second ends 380 b′and 380 b″.

The first tensioning strand 380 a can be stitched through the firstactuation strand 38 a, for instance through opposed ends of the firstactuation strand 38 a. For instance, the first tensioning stand 380 acan be threaded onto a needle, which is driven through the firstactuation strand 38 a, so as to insert the first tensioning strand 380 athrough the first actuation strand 38 a. The first tensioning strand 380a can extend through the first attachment portion 133 a and the firstactuation portion 131 a of the first actuation strand 38 a, and can loopback through the first actuation portion 131 a and the first attachmentportion 133 a, at a location between the first and second anchor bodies28 a and 28 b.

Similarly, the second tensioning strand 380 b can be stitched throughthe second actuation strand 38 b, for instance through opposed ends ofthe second actuation strand 380 b. For instance, the second tensioningstand 380 b can be threaded onto a needle, which is driven through thesecond actuation strand 38 b so as to insert the second tensioningstrand 380 b through the second actuation strand 38 b. The secondtensioning strand 380 b can extend through the first attachment portion133 b and the actuation portion 131 b of the second actuation strand 38b, and can loop back through the second attachment portion 133 b and thesecond actuation portion 131 b at a location between the first andsecond anchor bodies 28 a and 28 b.

Referring now to FIGS. 19A-B, the strand retention assembly 390 can beconstructed in accordance with an alternative embodiment to releasablyretain the at least one tensioning strand 380. Thus, while the strandretention assembly 390 illustrated in FIGS. 19A-B are illustrated asretaining the pair of first and second tensioning strands 380 a and 380b, the retention assembly 390 can alternatively releasably retain asingle tensioning strand, for instance as described above with respectto FIGS. 16-17. In accordance with the embodiment illustrated in FIGS.19A-B, the retention assembly 390 retains the first and second ends 380a′ and 380″ and 380 b′ and 380 b″ of the first and second tensioningstrands 380 a and 380 b. In accordance with one embodiment, theretention assembly 390 releasably retains the first and secondtensioning strands 380 a and 380 b. As will now be described, theretention assembly 390 is translatably fixed to the first pusherassembly 317, and thus moves proximally and distally along thelongitudinal direction L along with the plunger 316. Accordingly, afterthe second anchor body 28 b has been ejected from the cannula 310,movement of the plunger 316 and the push rod 330 in the proximaldirection causes the retention assembly 390 to move in the proximaldirection, thereby applying the tensile actuation force to the secondtensioning strand 380 b, which communicates the actuation force to thesecond actuation portion 131 b of the second actuation strand 38 b, andcauses the second anchor body 28 b to expand. Similarly, after the firstanchor body 28 a has been ejected from the cannula 310, movement of theplunger 316 and the push rod 330 in the proximal direction causes theretention assembly 390 to move in the proximal direction, therebyapplying the tensile actuation force to the first tensioning strand 380a, which communicates the actuation force to the first actuation portion131 a of the first actuation strand 38 a, and causes the first anchorbody 28 a to expand.

The retention assembly 390 includes a retention housing 392 having ahousing body 394 that is supported, directly or indirectly, by thecasing 308. In accordance with the illustrated embodiment, the retentionhousing 392 is disposed in the interior 328 of the casing 308, thoughthe retention housing 392 can alternatively be carried external of thecasing 308, and can be attached to the plunger 316 or any suitablealternative structure of the insertion instrument 300 as desired. Theretention housing 392 defines a bore 396 that extends longitudinallyinto the housing body 394 along the proximal direction. In accordancewith the illustrated embodiment, the bore 396 extends longitudinallythrough the housing body 394. The housing body 394 can define at leastone interior surface 398 that defines a perimeter of the bore 396. Theinterior surface 398 can slope (for instance linearly, curvilinearly, oralong any suitable alternative shape) radially outward as it travelsproximally along a direction from a distal end of the housing body 394to a proximal end of the housing body 394. Thus, the bore 396 can definea first cross-sectional dimension D3 along a direction substantiallyperpendicular to the longitudinal axis 302 at its first or proximal end,and a second cross-sectional dimension D4 along a directionsubstantially perpendicular to the longitudinal axis 302 at its secondor distal end. Because the bore 396 can be tapered, the firstcross-sectional dimension D3 can be less than the second cross-sectionaldimension D4. The bore 396 can be tapered, for instance linearly,curvilinearly, or along any suitable alternatively shape as desired.

The retention assembly 390 can further include a first locking member400 that is disposed inside the bore 396. The first locking member 400has a cross-sectional dimension D5, for instance along a directionsubstantially perpendicular to the longitudinal axis 302, that isbetween the first cross-sectional dimension D3 and the secondcross-sectional dimension D4. The first locking member 400 can besubstantially spherical as illustrated, or can alternatively define anyshape as desired. The retention assembly 390 is configured to retain atleast one strand between the first locking member 400 and the interiorsurface 398 of the housing body 394. For instance, the first end of atleast one or both of the tensioning strands 380 a′ and 380 b′ can extendbetween the first locking member 400 and the interior surface 398. Thefirst locking member 400 is configured to bear against the interiorsurface 398 during operation of the instrument, thereby capturing thefirst ends 380 a′ and 380 b′ between the first locking member 400 andthe interior surface 398 of the housing body 394, and preventingrelative movement between each of the first ends 380 a′ and 380 b′ andthe retention housing 392. Thus, the first locking member 400 canpresent a first locking surface, and the interior surface 398 canpresent a second locking surface that cooperates with the first lockingsurface so as to retain the first ends 380 a′ and 380 b′ of the firstand second retention strands 380 a and 380 b in the retention assembly390.

The retention assembly 390 can further include a second locking member402 that is configured to be attached to the first locking member 400.In particular, the second locking member 402 can include a threaded plug403 that is threadedly inserted into the proximal end of the housingbody 394. Accordingly, the second locking member 402 can be disposedadjacent the tapered inner surface 398, and can close the proximal endof the tapered bore 396. Alternatively, the second locking member 402can be integral with the housing body 394. The second locking member 402defines at least one opening, such as a longitudinal opening 404, thatis configured to receive the end of the one or more tensioning strandsthat are opposite the end of the tensioning strands that are capturedbetween the first locking member 400 and the interior surface 398 of thehousing body 394. Accordingly, the second locking member 402 isconfigured to receive each of the second ends 380 a″ and 380 b″ of thefirst and second tensioning strands 380 a and 380 b. The second lockingmember 402 can thus be aligned with the tapered bore 396, such that thesecond end 380 a″ and 380 b″ of each of the first and second strands 380a and 380 b extends through the tapered bore 396 and is attached to thesecond locking member 402.

In accordance with the illustrated embodiment, the longitudinal opening404 extends longitudinally between the bore 396 and the exterior of theplug 403, which can be the interior 328 of the casing 308. Each or bothof the second ends 380 a″ and 380 b″ can be tied in a knot 406 at theproximal end of the longitudinal opening 404, such that the knot 406abuts the proximal end of the second locking member 402. Thus, theretention assembly 390 is configured to fix the first and second ends380 a′ and 380 a″ of the first tensioning strand 380 a, and is furtherconfigured to fix the first and second ends 380 b′ and 380 b″ of thesecond tensioning strand 380 b. The second ends 380 a″ and 380 b″ canalternatively or additionally extend between the first locking member400 and the interior surface 398, and can be captured between the firstlocking member 400 and the interior surface 398 as desired so as toretain the second ends 380 a″ and 380 b″ in the retention assembly 390.The second locking member 402 can further include a second longitudinalopening 405 that is spaced from the longitudinal opening 404. The secondlongitudinal opening 405 is configured to receive the remainder of thefirst ends 380 a′ and 380 b′ that are captured between the first lockingmember 400 and the interior surface 398.

Referring to FIG. 19C, the first pusher assembly 317 can include a pairof flanges 319 that project out from the plunger 316 so as to define agap 321 that extends between the flanges 319. The gap 321 can be sizedto receive the housing body 394, such that each of the flanges 319 abutsthe proximal and distal ends of the housing body 394, respectively.Accordingly, proximal movement of the plunger 316 causes the distal oneof the flanges 319 to bias the housing body 394 and thus the retentionassembly 390, to move proximally along with the plunger 316, andtherefore also along with the push rod 330. Similarly, distal movementof the plunger 316 causes the proximal one of the flanges 319 to biasthe housing body 394 and thus the retention assembly 390, to movedistally along with the plunger 316, and therefore also along with thepush rod 330.

During operation, because the plunger 316 and the push rod 330 movedistally in tandem along the first stroke and the second stroke, andbecause the first and second anchor bodies 28 a and 28 b move distallyalong with the push rod 330, the retention assembly 390 likewise movesdistally along with the first and second anchor bodies 28 a and 28 b.Accordingly, the retention assembly 290 can operate so as to not inducetension in either of the first and second tensioning strands 380 a and380 b, and thus in the respective first and second actuation strands 38a and 38 b, before the first and second anchor bodies 28 a and 28 b havebeen ejected from the cannula 310. However, as will now be described,the insertion instrument 300, and in particular the plunger 316, can beactuated so as to apply the respective first and second actuation forcesto the first and second anchor bodies 28 a and 28 b after the first andsecond anchor bodies have been ejected from the cannula 310.

For instance, referring now to FIGS. 8A-D and FIGS. 19A-B, once theplunger 316 has traveled along the first stroke, thereby ejecting thesecond bone anchor 28 b from the cannula 310 at a location behind theanatomical structure 24 and the second anatomical location 24 b, theplunger 316 can be translated proximally such that the guide pin 344rides along the first track portion 342 a along the distal directionuntil contacting the collar 332, which provides stop surface at thedistal end of the first track portion 342 a, thereby preventing furtherproximal translation of the plunger. Because contact between theanatomical structure 24 and the second anchor body 28 b prevents thesecond anchor body 28 b from translating proximally along with theretention assembly 390, the retention assembly applies a tensile forceto the tensioning strand 380 b, which is communicated to the secondactuation strand 38 b as the actuation force that causes the secondanchor body 28 b to move from the first configuration illustrated inFIG. 9A to the expanded configuration illustrated in FIG. 9E.

For instance, referring now to FIGS. 9A-E and FIGS. 19A-B, once theplunger 316 has traveled along the first stroke, thereby ejecting thesecond bone anchor 28 b from the cannula 310 at a location behind theanatomical structure 24 at the second anatomical location 24 b, theinsertion instrument 300 can be translated proximally as it is removedfrom the anatomical tissue 24 as described above. Because contactbetween the anatomical structure 24 and the second anchor body 28 bprevents the second anchor body 28 b from translating proximally alongwith the insertion instrument 300, the retention assembly 390 applies atensile force to the tensioning strand 380 b, which is communicated tothe second actuation strand 38 b as the actuation force that causes thesecond anchor body 28 b to move from the first configuration illustratedin FIG. 9A to the expanded configuration illustrated in FIG. 9E.

Similarly, referring now to FIGS. 18A-E and FIGS. 19A-B, once theplunger 316 has traveled along the second portion of the second stroke,thereby ejecting the first bone anchor 28 a from the cannula 310 at alocation behind the anatomical structure 24 at the first anatomicallocation 24 a, the insertion instrument 300 can be translated proximallyas it is removed from the anatomical tissue 24. Because contact betweenthe anatomical structure 24 and the first anchor body 28 a prevents thefirst anchor body 28 a from translating proximally along with theretention assembly 390, the retention assembly 390 applies a tensileforce to the first tensioning strand 380 a, which is communicated to thefirst actuation strand 38 a as the actuation force that causes the firstanchor body 28 a to move from the first configuration illustrated inFIG. 12A to the expanded configuration illustrated in FIG. 12E.

Once the first and second anchor bodies 28 a and 28 b have been actuatedto their expanded configurations, the tensioning strands 380 a and 380 bcan be released from the retention assembly 390. For instance, as willnow be described, the retention assembly 390 can configured to releaseat one of the ends of the tensioning strands 380 a and 380 b.Alternatively, as described in more detail below, the insertioninstrument 300 can include a cutting blade that is configured to severthe first and second tensioning strands 380 a and 380 b. Referring toFIG. 19C, the insertion instrument 300 can include a release member 408that is coupled to the retention assembly 390 and is configured toiterate the retention assembly 390 to an unlocked configuration. Therelease member 480 can include any suitable linkage 410 that can bealigned with the first locking member 400. The release member 408 caninclude an actuator 414 that is carried by the casing 308 and coupled tothe linkage 410, such that a user can manipulate the actuator 414, forinstance slide the actuator proximally, so as to cause the linkage 410to contact the first locking member 400 and bias the first lockingmember 400 proximally along the direction of Arrow 401 to an unlockedconfiguration, which creates a gap 412 between the first locking member400 and the interior surface 398, as illustrated in FIG. 19B. The gapcan be greater than a cross-sectional dimension of the tensioningstrands 380 a and 380 b.

When the second ends 380 a″ and 380 b″ are tied at the second lockingmember 402, proximal translation of the insertion instrument 300relative to the implanted anchor bodies 28 a and 28 b, causes the firstends 380 a′ and 380 b′ of the first and second tensioning strands 380 aand 380 b to travel out the retention assembly 390 through the gap, andfurther draws the respective first and second tensioning strands 380 aand 380 b through the respective actuation strands 38 a and 38 b,thereby removing the first and second tensioning strands 380 a and 380 bfrom the actuation strands 38 a and 38 b as illustrated in FIGS.18C-18D. Alternatively, if the first and second ends 380 a″ and 380 b″are retained by the first locking member 400 and not the second lockingmember 402, proximal translation of the insertion instrument 300relative to the implanted anchor bodies 28 a and 28 b removes thetensioning strands 380 a and 380 b from the insertion instrument 300.The user can then manually draw the tensioning strands 380 a and 380 bthrough the respective actuation strands 38 a and 38 b so as to removethe first and second tensioning strands 380 a and 380 b from theactuation strands 38 a and 38 b.

Referring now to FIG. 18D, once the tensioning strands 380 a and 380 bhave been removed from the actuation strands 38 a and 38 b, the user candraw the connector 63 toward the anatomical structure. It should beappreciated that the connector 63 can be attached to the actuationstrands 38 a and 38 b when the first and second anchor bodies 28 a and28 b are loaded in the insertion instrument 300. Alternatively, the usercan connect the actuation strands 38 a and 38 b after the first andsecond anchor bodies 28 a and 28 b have been ejected. While theconnector member 63 illustrated in FIGS. 18C-E is configured as a knotof the type described above, the connector member 63 can bealternatively configured as desired. In accordance with the embodimentillustrated in FIGS. 18C-E, a tensile force can be applied to the freeend 70, which causes the connector member to translate toward theanatomical structure, thereby applying an approximation force to theactuation strands 38 a and 38 b, thereby approximating the tissue gap 24c. The portion of the actuation strands 38 a and 38 b that extend outfrom the connector member 63 can then be severed as desired.

Referring now to FIGS. 20A-B, and as described above, the insertioninstrument 300 can include a cutting assembly 416 that includes acutting blade 418, and is movable between a disengaged position wherebythe cutting blade 418 is spaced from one of the ends, such as the firstends 380 a′ and 380 b′ of the tensioning strands 380 a and 380 b thatare retained by the retention assembly 390, and an engaged positionwhereby the cutting blade severs the first ends 380 a′ and 380 b′ of thetensioning strands 380. It should be appreciated that the retentionassembly 390 illustrated in FIGS. 20A-B can be configured as illustratedin FIG. 17, and that the retention assembly 390 can be attached to asingle tensioning strand, such that the cutting blade 418 is configuredto cut a first end of the single tensioning strand, such that removal ofthe insertion instrument 300 from the anchor bodies 28 a and 28 b drawsthe tensioning strand through and away from actuation strands 38 a and38 b.

The cutting assembly 416 can include a longitudinally elongate shaft420, and a switch 422 that is pivotally coupled between the elongateshaft 420 and the cutting blade 418, thereby coupling the elongate shaft420 to the cutting blade 418. The cutting blade 418 can be carried by ablade housing 424, such that the elongate shaft 420 and the switch 422are indirectly coupled to the cutting blade 418. The proximal end of thelongitudinally elongate shaft 420 can extend proximally out of thecasing 408, and the longitudinal shaft can extend in a side wall of thecasing 408. The shaft 420 is movable longitudinally in the distaldirection from a disengaged position to an engaged position. Distalmovement of the shaft 420 causes the switch to pivot, thereby drivingthe cutting blade 418 to translate proximally and into the first ends380 a′ and 380 b′ of the first and second tensioning strands 380 a and380 b, thereby severing the first ends 380 a′ and 380 b′. Once thetensioning strands 380 a and 380 b have been severed, the instrument canbe translated proximally with respect to the ejected anchor bodies 28 aand 28 b so as to remove the tensioning strands 380 a and 380 b from therespective actuation strands 38 a and 38 b in the manner describedabove.

Referring now to FIGS. 21A and 21B, it should be appreciated that thecutting assembly 416 can be constructed in accordance with anyalternative embodiment as desired. For instance, the cutting assembly416 can include an actuator 426 that extends laterally out the side wallof the casing 408 along a direction angularly offset with respect to thelongitudinal direction L, and is movable radially inward from thedisengaged position to the engaged position. The actuator 426 can carrythe cutting blade 418. Accordingly, as the actuator 426 moves radiallyinward, the cutting blade 418 severs the first and second ends 380 a′and 380 b′ of the actuation strands 380 a and 380 b. The insertioninstrument 300 can include a divider wall 428 that separates the firstand second ends of the actuation strands 380 a and 380 b and is alignedwith the cutting blade 418. Accordingly, the cutting blade 418 drivesinto the divider wall 428 and does not sever the second ends of thefirst and second actuation strands 380 a and 380 b. Of course, it shouldbe appreciated that a single tensioning strand can be coupled to theactuation strand 38 of the anchor assembly 20 as described above, suchthat the cutting blade 418 can cut one of the first and second ends ofthe single tensioning strand.

Referring now to FIGS. 22A-D generally, the insertion instrument 300 canbe constructed substantially as described above with respect to FIG.7A-21B, but can include the guide system 329 that operably couples thecasing 308 and the push rod 330 so as to guide relative movement betweenthe casing 308 and the push rod 330 in accordance with anotherembodiment. For instance, the guide track 342 can be defined in thecollar 332 as described above, but extends substantially linearly alongthe longitudinal direction L. Accordingly, as the plunger translatesdistally along the first and second strokes, the guide track 342translates linearly with respect to the guide pin 344. It should beappreciated in the embodiment illustrated in FIGS. 22A-D, the secondrecess 362 illustrated in FIGS. 13C-E can be longitudinally aligned withthe first recess 354, such that the latch 370 moves from the firstrecess 354 into the second recess 362 so as to decouple the plunger 316from the collar 332 without rotating the plunger 316. The plunger 316can include a shaft portion 430 that defines a portion of the key 318 asdescribed above, and a distal end cap that can define a grip portion 432that extends radially out from the proximal end of the shaft portion430. The collar 332 can extend at least partially around the shaftportion 430, and can extend radially out from the shaft portion 430 inaccordance with the illustrated embodiment.

The insertion instrument 300 can further include a clip 434 that has alongitudinal length substantially equal to the longitudinal distancebetween the grip portion 432 of the plunger 316 and the proximal end ofthe collar 332 when the plunger 316 is in the first position. The clip434 can be removably secured to the shaft portion 430 of the plunger316. Thus, as the plunger 316 translates distally, the grip portion 432biases the clip 434 against the collar 332, which causes the collar 332to translate along with the plunger 316. It should therefore beappreciated that the clip 434 couples the plunger 316 and the collar 332with respect to distal translation along the longitudinal direction L.Accordingly, during operation, the plunger 316 and collar 332 can betranslated distally from the first position to the second position intandem along the first stroke in the manner described above. As theplunger 316 and collar 332 move along the first stroke, the guide pin344 translates proximally within the entire guide track 342. The plunger316 and collar 332 reach the second position when the clip 434 abuts thecasing 308, at which point the latch member 370 moves from the firstrecess 354 into the second recess 358 as described above with respect toFIGS. 14C-D. Next, the clip 434 can be removed from the plunger 316, andthe plunger 316 can translate distally with respect to the collar 332along the second stroke. It should be appreciated that the plunger 316can translate along the entire second stroke independent of the collar332.

Accordingly, the push tube 334 ejects the second anchor body 38 b asdescribed above with respect to FIGS. 9A-E after the plunger and collar332 have moved along the first stroke from the first position to thesecond position. Thus, the plunger 316 can be depressed a first distancethat causes the second anchor body 28 b to be ejected from the insertioninstrument, and the clip 434 abuts the casing 308 once the plunger 316has been depressed the first distance so as to prevent the plunger 316from being depressed a second distance greater than the first distanceuntil the collar 434 is removed from the plunger 316. The push rod 330can then eject the first anchor body 28 a after the plunger 136 hasmoved from the second position to the third position along the secondstroke in the manner described above with respect to FIGS. 12A-E. Theguide pin 344 can abut the proximal end of the guide track 342 when thesecond stroke has been completed. Furthermore, the grip portion 432 ofthe plunger 316 can abut the casing 308 once the plunger 316 hascompleted the second stroke and has moved to the third position. Itshould be appreciated in the embodiment illustrated in FIGS. 22A-D thatbecause the plunger 316 is rotatably keyed to the collar 332 and thusrotatably fixed to the collar 332, and because the latch 370 (describedabove) rotatably couples the collar 332 to the casing 308, the plunger316 is unable to rotate with respect to the casing 308 as the plunger316 translates along the second stroke. Alternatively, the insertioninstrument can be configured to allow the plunger 316 to rotate asdesired so as to align the latch 370 with the second recess 362, asdescribed above.

As described above with respect to the insertion instrument illustratedin FIGS. 7A-13G, the guide track 342 can be carried by the casing 308,and the guide pin 344 can be carried by one of the pusher assemblies.Referring now to FIG. 23A, the insertion instrument 300 includes atleast one guide track, such as a first guide track 446 that is carriedby the casing 308, and at least a one guide member such as a first guidepin 448 carried by the pusher assembly 317, and in particular carried bythe plunger 316, that rides in the first guide track 342.

As illustrated in FIG. 23B, the shaft portion 430 of the plunger 316defines a distal surface 431, and further defines a first centralaperture 440 that extends longitudinally into, or distally into, thedistal surface 431. The shaft portion 430 of the plunger 316 furtherdefines a radial aperture 435 that receives the guide pin 448. The firstaperture 440 receives the push rod 330, such that the plunger 316 andthe push rod 330 are coupled to each other with respect to bothlongitudinal translation and rotation. As illustrated in FIG. 23D, thepush rod 330 extends from the plunger 316 and into the cannula 310,which is fixed to the casing 308 with respect to translation androtation. Referring also to FIG. 23C, the tip 311 can be cannulated soas to define a distal ejection port 442 that is substantially alignedwith the longitudinal axis 302, and thus also substantially aligned withthe elongate opening 312 of the cannula 310. The push rod 330 is movablelongitudinally inside the channel 312 in the manner described above. Itshould be appreciated that the insertion instrument 300 canalternatively define a side ejection port constructed substantially asdescribed below. The cannula 310 can define a longitudinal slot 337,such that the attachment portions 133 a and 133 b of the actuationstrands 38 a and 38 b (see FIG. 1A) that attach the first anchor body 28a to the second anchor body 28 b can extend out the slot 337.

Referring now also to FIGS. 23D-E, the insertion instrument includes aguide system 444 that is configured to operably couple the casing 308 tothe push rod 330 so as to guide relative movement between the casing 308and the push rod 330. For instance, the guide system 444 includes thefirst guide member in the form of the first guide track 446 that iscarried by the casing 308, and the second guide member illustrated asthe first guide pin 448 that extends from the pusher assembly 317. Thefirst guide track 446 can be configured as a slot that extends radiallyoutward into the radially inner surface of the casing 308. Furthermore,in accordance with the illustrated embodiment, the first guide pin 448extends radially out from the shaft portion 430 of the plunger 316, andrides within the first guide track 448. The first guide track 446defines a first track portion 446 a that extends substantiallylongitudinally, and an intermediate track portion 446 b that extendscircumferentially from the distal end of the first track portion 446 a.

With continuing reference to FIG. 23E, the guide system 444 furtherincludes a third guide member configured as a second guide track 450that is carried by the casing 308, and is configured as a slot thatextends radially outward into the inner surface of the casing 308. Thesecond guide track 450 defines a first track portion 450 a that extendssubstantially longitudinally, and an intermediate track portion 450 bthat extends circumferentially from the distal end of the second guidetrack 450 b. The intermediate track portion 450 b extends from the firsttrack portion 450 a the same direction that the intermediate trackportion 446 b extends from the first track portion 446 a.

The first track portions 446 a and 450 a define a first stroke ofmovement for the plunger 316 that causes the push rod 330 to eject thesecond anchor out the ejection port 442. The intermediate track portions446 ba and 450 b are configured such that the plunger is rotated so asto align a fifth guide member with a second track portion that isradially offset from the first track portions 446 a and 450 a. Inparticular, as illustrated in FIG. 23B, the insertion instrument 330further includes a pair of apertures 452 that are disposed adjacent thecentral aperture 440 and extend longitudinally into the distal surface431 of the shaft portion 430 of the plunger 416. The apertures 452 areeach configured to receive respective fifth guide members configured asguide posts 454 (FIG. 23D) that extend distally from the plunger 416,and a sixth guide member illustrated as a guide housing 460 (FIG. 23E)that is disposed in the interior 328 of the casing 308 and fixed to thecasing 308 with respect to translation. The guide housing 460 defines aseventh guide member configured as a radially outwardly extending secondguide pin 461 that is configured to ride in the second guide track 450.The guide housing 460 further defines a guide member in the form of atleast one aperture such as a pair of apertures that extendlongitudinally through the guide housing 460 and define second trackportions 462. The second track portions 462 are sized to receive theguide posts 454. The proximal end of the guide housing 460 can define apair of recesses 464 that extend longitudinally into, but not through,the guide housing 460 at a location adjacent the second track portions462. The recesses 464 can be arcuate shaped or alternatively shaped asdesired.

Referring now to FIGS. 23A and 23F, a distal biasing force can beapplied to the plunger 316, which causes the plunger 316 and the pushrod 330 to translate distally along the first stroke with respect to thecasing 308 and thus the cannula 310 and the guide housing 460. Theplunger 316 translates from the first position illustrated in FIG. 23Ato the second position illustrated in FIG. 23F. As the plunger 316translates distally from the first position to the second position, thefirst guide pin 448 translates distally along the first track portion446 a of the first guide track 446 until the first guide pin 448 isaligned with the intermediate track portion 446 b of the first guidetrack 446. Likewise, as the plunger 316 translates distally from thefirst position to the second position, the second guide pin 461translates distally in the first track portion 450 a of the second guidetrack 450 until the second guide pin 461 is aligned with theintermediate track portion 450 b of the second guide track 450. Once theplunger 316 has translated to the second position, the guide posts 454are circumferentially offset from the respective second track portions462, and abut the guide housing 460, for instance in the recesses 464.

Referring now to FIG. 23G, the plunger 316 can be rotated along thedirection of Arrow 456, which causes the first and second guide pins 448and 461 to travel in the respective intermediate track portions 446 band 450 b, until reaching the end of the intermediate track portions 446b and 450 b, which define respective stops that prevent the plunger 316from continuing to rotate relative to the casing 308, and furtherprevents the guide posts 454 from rotating relative to the guide housing460. Once the plunger 316 has finished rotating, the guide posts 454 arealigned with the second track portions 462. Accordingly, as illustratedin FIG. 23H, the plunger 316 can be further translated distally alongthe second stroke from the second position to a third position, at whichpoint the plunger 316 abuts the guide housing 460 and is prevented fromtraveling distally further. Thus, the guide housing 460 defines a stopthat prevents the plunger 316 from translating distally beyond the thirdposition.

As the plunger 316 translates along the second stroke, the push rod 330translates distally within the channel 312 of the cannula 310, andejects the first anchor body 28 a out the ejection port 442. After eachanchor body 28 a and 28 b has been ejected from the instrument to alocation behind the anatomical structure 24 (see FIG. 1A), an actuationforce can be applied to each anchor body 28 a and 28 b. For instance,the insertion instrument 330 can include a retention assembly of thetype described above, such as the retention assembly 390 or any suitablealternatively constructed retention assembly. Alternatively, the usercan manually apply the actuation force to the respective actuationstrands 131 a and 131 b. A connector member can then attach theactuation strands 131 a and 131 b together in the manner describedabove.

Referring now to FIGS. 24A-25D generally, it should be appreciated thatan insertion instrument can be configured having a first and secondcannulas supported by the casing in a side-by-side orientation thatretain first and second anchor bodies, and first and second pusherassemblies operatively associated with the first and second cannulas,respectively, so as to eject the first and second anchor bodies out therespective first and second cannulas. It can be desirable to ensure thata desired cannula from which the anchor body is to be ejected isdistally disposed with respect to the other cannula, such that thedesired cannula can be inserted into the underlying tissue without alsoinserting the other cannula.

As illustrated in FIG. 24A, an insertion instrument 300 includes acasing 308 that includes a body portion 308 a and a handle portion 308 bthat extends out from the body portion 308 a. The insertion instrument300 further includes a first cannula 310 a that extends distally fromthe casing 308, and in particular from the body portion 308 a, and asecond cannula 310 b that extends distally from the casing 308, and inparticular from the body portion 308 a, at a location adjacent the firstcannula 310 a. The first and second cannulas 310 a and 310 b can extendsubstantially parallel to each other as illustrated. Accordingly, thefirst and second cannulas 310 a and 310 b can be described as being in aside-by-side relationship. The first and second cannulas 310 a and 310 bcan define respective longitudinally elongate channels 312 a and 312 bthat retain respective first and second anchor bodies 28 a and 28 b.

The insertion instrument 300 can further include first and second pusherassemblies 317 a and 317 b operatively associated with the first andsecond cannulas 310 a and 310 b, respectively. Thus, the first pusherassembly 317 a is configured to eject the first anchor body 28 a out thefirst cannula 310 a, and the second pusher assembly 317 b is configuredto eject the second anchor body 28 b out the second cannula 310 b. Thefirst and second cannulas 310 a and 310 b can define respective firstand second tapered tips 311 a and 311 b, and first and second distalejection ports that extend longitudinally through the respective tips311 a and 311 b.

Each of the first and second pusher assemblies 317 a and 317 b includesfirst and second plungers 316 a and 316 b, respectively, and first andsecond pusher rods 330 a and 330 b, respectively, that extend distallyfrom the corresponding plungers 316 a and 316 b. Each of the plungers316 a and 316 b define respective shaft portions 430 a and 430 b andrespective end caps that can define first and second grip portion 432 aand 432 b that extends radially out from the proximal end of thecorresponding shaft portions 430 and 430 b. When the first and secondplungers 316 a and 316 b are in their respective first positions, thefirst and second grip portions 432 a and 432 b are proximally spacedfrom the casing 308. The insertion instrument 300 can further includefirst and second lock-out tabs 468 a and 468 b that are removablyattached to the first and second plungers 316 a and 316 b. For instance,in accordance with the illustrated embodiment, the first and secondlock-out tabs 468 a and 468 b are attached to the respective first andsecond shaft portions 430 a and 430 b at a location longitudinallybetween the corresponding grip portions 432 a and 432 b and the casing308. Accordingly, the first and second lock-out tabs 468 a and 468 binterfere with the respective grip portions 432 a and 432 b, and preventthe plungers 316 from translating distally relative to the casing 308 toa depth that would eject the respective first and second anchor bodies28 a and 28 b.

The insertion instrument 330 can further include a swap actuator 470 inthe form of a trigger that extends partially into the casing 308, andcan extend out from the handle portion 308 b. The swap actuator 470 isconfigured to be moved from a first position to an actuated position soas to reverse a relative position of the fist and second tips 311 a and311 b. The swap actuator 470 can be coupled to the first pusher assembly317 a, such that proximal translation of the actuator 470 causes thefirst pusher assembly 317 a, including the first plunger 316 a and thefirst cannula 310 a, to translate proximally. As illustrated in FIG.24A, the first tip 311 a of the first cannula 310 a is disposed distallywith respect to the second tip 311 b of the second cannula 310 b.Furthermore, the distal end of the second push rod 330 b can extendslightly out from the respective second tip 311 b, such that thelongitudinal distance between the distal end of the second push rod 330b and the distal end of the first tip 311 a defines an insertion depthinto underlying tissue. Otherwise stated, the second push rod 330 b candefine a depth stop for insertion of the first tip 311 a into underlyingtissue. It should thus be appreciated that the first tip 311 a can beinjected into underlying tissue, for instance at the first targetanatomical location 24 a (see FIG. 1A) without causing the second tip311 b to inject into the underlying tissue. As is described in moredetail below, actuation of the swap actuator 470 from a first positionto a second position causes the first tip 311 a to move proximally withrespect to the casing 308 and the second tip 311 b, such that the secondtip 311 b can be injected into the underlying tissue, for instance atthe second target anatomical location 24 b (see FIG. 1B) without causingthe first tip 311 a to inject into the underlying tissue.

During operation, referring to FIG. 24B, the first lock-out tab 468 acan be removed from the first plunger 316 a, such that the first plunger316 a can travel distally with respect to the casing 308 from the firstposition illustrated in FIG. 24A to a second position as illustrated inFIG. 24C, whereby the first grip portion 432 a abuts the casing 308.Because the first push rod 330 a is translatably fixed to the firstplunger 316 a, distal translation of the first plunger 316 a causes thefirst push rod 330 a to likewise translate in the first cannula 310 a.The first push rod 330 a abuts the first anchor body 28 a, such thatdistal translation of the first push rod 330 a ejects the first anchorbody 28 a out the first ejection port, for instance into the firsttarget anatomical location.

Next, referring to FIG. 24D, the second lock-out tab 468 b can beremoved from the second plunger 316 b, as illustrated in FIG. 24D.Referring to FIG. 24E, the swap actuator 470 can be actuated, forinstance can be moved proximally, to retract the first tip 311 aproximally with respect to the second cannula 310 b until the first tip311 a is disposed proximally with respect to the second tip 311 b.Furthermore, the distal end of the first push rod 330 a can extendslightly out from the respective first tip 311 a, such that thelongitudinal distance between the distal end of the first push rod 330 aand the distal end of the second tip 311 b defines an insertion depth ofthe second tip 311 b into the underlying anatomical structure. Otherwisestated, the first push rod 330 a can define a depth stop for insertionof the second tip 311 a into underlying tissue. It should thus beappreciated that the second tip 311 b can be injected into underlyingtissue, for instance at the second target anatomical location 24 b (seeFIG. 1A) without causing the first tip 311 a to inject into theunderlying tissue. In accordance with the illustrated embodiment,actuation of the swap actuator 470 further causes the first plunger 316a to translate proximally to the first position illustrated in FIG. 24A.

Referring now to FIG. 24F, the second plunger 316 b can travel distallywith respect to the casing 308 from the first position illustrated inFIG. 24E to a second position as illustrated in FIG. 24F whereby thesecond grip portion 432 b abuts the casing 308. Because the second pushrod 330 b is translatably fixed to the second plunger 316 b, distaltranslation of the second plunger 316 b causes the second push rod 330 bto likewise translate in the second cannula 310 b, thereby ejecting thesecond anchor body 28 b out the second ejection port 442 b and into thesecond target anatomical location.

Operation of the insertion instrument 300 illustrated in FIGS. 24A-25Dwill now be further described with particular reference to FIGS. 25A-D.In particular, the insertion instrument 300 includes at least one latchassembly such as a first latch assembly 305 a, a second latch assembly305 b, and a third latch assembly 305 c. The first latch assembly 305 ais configured to lock the swap actuator 470 in its proximal positiononce it has been moved proximally from a first position illustrated inFIG. 24D to a second recessed position illustrated in FIG. 24E. Forinstance, the first latch assembly 305 can include a latch member 307that is supported by the casing 308 extends proximally toward a proximalabutment surface 307 a configured to abut the swap actuator 470 once theswap actuator 470 is in its second proximal position, therebyinterfering with distal movement of the swap actuator 470 relative tothe casing 308. As the swap actuator 470 moves proximally, the latchmember 307 can deflect inwardly away from the swap actuator 470 so as toallow proximal translation of the swap member 470 relative to the latchmember 307. Once the swap actuator 470 has been moved from its firstinitial position to its second proximal position relative to the casing308, the latch member 307 moves outward under its spring force such thatthe proximal abutment surface 307 a abuts the swap actuator 470 andprevents the swap actuator 407 from moving distally from its secondposition with respect to the casing 308.

The second latch assembly 305 b includes a first latch member 347carried by the swap actuator 470 and movable with the swap actuator 470,and a second latch member 349 that is carried by the first plunger 316a, and is movable with the first plunger 316 a. The first latch member347 is attached to the first cannula 310 a, such that the first latchmember 347 causes the first cannula 310 a to translate with the swapactuator 470. The second latch member 349 includes a body 349 a, a firstattachment portion such as a hook at the distal end of the body 349 a,and a second attachment portion such as an abutment surface at theproximal end of the body (the second latch member 349 can be constructedas the mirror image of the second latch member 353 of the third latchassembly 305 c described below). Accordingly, as the first plunger 316 ais translated from its first position illustrated in FIG. 24A to itssecond position illustrated in FIG. 24B, the hook deflects inwardly awayfrom the first latch member and rides along and past the first latchmember 347. Once the first plunger 316 a is in its second positionillustrated in FIG. 24B such that the first anchor body 28 a has beenejected, the hook of the second latch member 349 moves outward under itsspring force such that the hook is disposed distal of the first latchmember 347, and the abutment surface of the second latch member isdisposed proximal of the first latch member 347. Accordingly, the firstlatch member 347 is captured between the hook of the second latch member349 and the abutment surface of the second latch member 349. Thus, thefirst and second latch members 349 are coupled with respect totranslation.

Accordingly, once the first anchor body 28 a has been ejected from thefirst cannula 310 a, the second latch member 349 is attached to thefirst latch member 347, which translatably couples the first plunger 316a to the swap actuator 470 with respect to translation. Furthermore,because the first latch member 347 is carried by the swap actuator 470and is further attached to the first cannula 310 a, movement of the swapactuator 470 proximally causes both the first cannula 310 a and thefirst plunger 316 to move proximally to a position whereby the first tip311 a and the first push rod 330 a are disposed proximal with respect tothe second tip 311 b, while the first push rod 330 a remains disposeddistal of the first tip 311 a. Furthermore, because the first plunger316 a is coupled to the swap actuator 470 with respect to relativetranslation both proximally and distally, and because the swap actuator470 is coupled to the casing 308 with respect to at least proximaltranslation, the first plunger 316 is prevented from translatingproximally with respect to the casing 308 once the first anchor body 28a has been ejected. The first push rod 330 a can thus provide aninsertion depth stop for the second tip 311 b as described above.

The third latch assembly 305 c includes a first latch member 351 carriedby the casing 308, and a second latch member 353 carried by the secondplunger 316 b. The second latch member 353 includes a body 353 a, afirst attachment portion 353 b such as a hook at the distal end of thebody 353 a, and a second attachment portion 353 c such as an abutmentsurface disposed at the proximal end of the body 353 a. When the secondplunger 316 b is translated distally from its first position illustratedin FIG. 24E to its second distal position illustrated in FIG. 24F, forinstance when ejecting the second anchor body 28 b, the hook can deflectinwardly, away from the first latch member 351 and ride along and movepast the first latch member 351. Once the second plunger 316 b is in itssecond position illustrated in FIG. 24F such that the second anchor body28 b has been ejected, the hook of the second latch member 353 movesoutwardly under its spring force at a location distal of the first latchmember 351, and the abutment surface of the second latch member 353 isdisposed proximal of the first latch member 351. The first latch member351 is thus captured between the hook of the second latch member 353 andthe abutment surface of the second latch member 353. As a result, thesecond plunger 316 b is prevented from moving proximally or distallywith respect to the casing 308 once the second anchor body 28 b has beenejected, and the blunt distal end of the second push rod 330 b remainsdistal to the second tip 311 b.

Once the anchor bodies 28 a and 28 b have been ejected, a tensile forcecan be applied to the actuation portions 131 a and 131 b (see FIG. 1A)so as to expand the anchor bodies 28 a and 28 b in the manner describedabove. For instance, first and second tensioning strands 380 a and 380 b(see FIGS. 18A-18B) can be attached between the respective actuationportions 131 a and 131 b, and the respective lock-out tabs 468 a and 468b. Accordingly, after the lock-out tabs 468 a and 468 b have beenremoved from the respective plungers 316 a and 316 b and the respectivefirst and second anchor bodies 28 a and 28 b have been ejected, proximalmovement of the lock-out tabs 468 a and 468 b with respect to the anchorbodies 28 a and 28 b causes the tensile force to be applied to thecorresponding tensioning strands 380 a and 380 b, which communicates thetensile force to the actuation portions 131 a and 131 b so as to expandthe anchor bodies 28 a and 28 b. Alternatively, the tensioning strands380 a and 380 b can be secured in the casing 308 in any manner describedabove.

Referring now to FIGS. 26A-B, the insertion instrument 300 can include aretention assembly 490 constructed in accordance with an alternativeembodiment that is configured to apply an actuation force to the firstand second actuation strands 38 a and 38 b (see FIG. 1A). For instance,the retention assembly 490 can retain the first and second actuationstrands 38 a and 38 b directly. In accordance with the illustratedembodiment, the retention assembly 490 retains both the actuationportions 131 a and 131 b and the attachment portions 133 a and 133 b ofthe first and second anchor bodies 28 a and 28 b, respectively, forinstance when the attachment portions 133 a and 133 b are not attachedwhen loaded in the insertion instrument 300. Alternatively, if theattachment portions 133 a and 133 b are pre-attached to each other whenloaded in the insertion instrument 300, the retention assembly canretain only the actuation portions 131 a and 131 b. Alternatively still,as described above, at least one tensioning strand can be stitchedthrough the first and second actuation strands 38 and 38 b,respectively, and can further be retained in the retention assembly 490.Regardless of the configuration, the retention assembly can beconfigured to apply an actuation force to the actuation strands 38 a and38 b that causes the respective anchor bodies 28 a and 28 b to move totheir expanded configurations.

In accordance with the illustrated embodiment, the retention assembly490 can be mounted to either or both of the cannulas, such as the firstcannula 310 a as shown in FIG. 26A. The retention assembly 490 caninclude a first locking member such as a retention housing 492 that ismounted to the first cannula 310 a and defines a lateralstrand-receiving gap 493 extending therein. In particular, the retentionhousing includes a first or proximal housing portion 492 a and a secondor distal housing portion 492 b, such that the gap 493 is disposedbetween the first and second housing portions 492 a and 492 b. Theretention assembly 490 can further include a second locking member suchas a pincher 494 that can be threadedly mounted to the retention housing492, for instance to the first housing portion 492 a at a location isaligned with the gap 493. Rotation of the pincher 494 relative to theretention housing 492 in a first direction causes the pincher 494 totranslate into the gap 493 toward the second housing portion 492 b.Rotation of the pincher 494 relative to the retention housing 492 in asecond direction opposite the first direction causes the pincher 494 totranslate out of the gap 493 and away from the second housing portion492 b.

Accordingly, during operation, one or more target strands 379, such asthe actuation strand or strands 38 a and 38 b or at least one tensioningstrand can be loaded into the gap 493, and the pincher 494 can berotated in the first direction until the retention assembly 490 capturesthe target strands 379 between a distal end of the pincher 494 and thesecond housing portion 492 b. Once the first and second anchor bodies 28a and 28 b have been ejected into the respective first and second targetanatomical locations (see FIG. 1A), the insertion instrument can betranslated proximally away from the anatomical location, therebyapplying the actuation force, either directly or indirectly, to thefirst and second actuation strands 38 a and 38 b, thereby actuating theanchor bodies 28 a and 28 b to their expanded configurations. The pincer494 can then be rotated along the second direction so as to increase thegap 493 until the insertion instrument 300 can be pulled free from thetarget strands 379. Alternatively or additionally, for instance when thetarget strands 379 are provided as tensioning strands, the tensioningstrands can be cut while captured in the retention assembly 490. Becausethe cannulas 310 a and 310 b can define longitudinal slots that extendthrough one side of the cannulas 310 a and 310 b, the actuation strands38 a and 38 b can be freed from the respective cannula, for instance outthe longitudinal slot, when the corresponding anchor bodies 28 a and 28b are ejected from the cannula.

Referring now to FIGS. 27A-28B generally, the insertion instrument 300can be configured having a first and second cannulas 310 a and 310 bsupported by the casing 308 in a side-by-side orientation that retainfirst and second anchor bodies 28 a and 28 b, and first and secondpusher assemblies 317 a and 317 b operatively associated with the firstand second cannulas 310 a and 310 b, respectively, so as to eject thefirst and second anchor bodies 28 a and 28 b out the respective firstand second cannulas 310 a and 310 b. Furthermore, as described above, itcan be desirable to ensure that a desired cannula from which the anchorbody is to be ejected is distally disposed with respect to the othercannula, such that the desired cannula can be inserted into theunderlying tissue without also inserting the other cannula.

As illustrated in FIG. 27A, the insertion instrument 300 includes acasing 308 that includes a body portion 308 a and a handle portion 308 bthat extends out from the body portion 308 a. The insertion instrument300 further includes a first cannula 310 a that extends distally fromthe casing 308, and in particular from the body portion 308 a, and asecond cannula 310 b that extends distally from the casing 308, and inparticular from the body portion 308 a, at a location adjacent the firstcannula 310 a. The first and second cannulas 310 a and 310 b can extendsubstantially parallel to each other as illustrated. Accordingly, thefirst and second cannulas 310 a and 310 b can be described as being in aside-by-side relationship. The first and second cannulas 310 a and 310 bcan define respective longitudinally elongate channels 312 a and 312 bthat retain respective first and second anchor bodies 28 a and 28 b.

The insertion instrument 300 can further include first and second pusherassemblies 317 a and 317 b operatively associated with the first andsecond cannulas 310 a and 310 b, respectively. Thus, the first pusherassembly 317 a is configured to eject the first anchor body 28 a out thefirst cannula 310 a, and the second pusher assembly 317 b is configuredto eject the second anchor body 28 b out the second cannula 310 b. Thefirst and second cannulas 310 a and 310 b can define respective firstand second tapered tips 311 a and 311 b, and first and second distalejection ports 442 a and 442 b that extend longitudinally through therespective tips 311 a and 311 b.

Each of the first and second pusher assemblies 317 a and 317 b includesfirst and second plungers 316 a and 316 b, respectively, that extendsout the casing 308, such as the body portion 308 a of the casing 308.The first and second plungers 316 a and 316 b can extend proximally outthe casing 308 as described above with respect to FIGS. 24A-F, or canextend out the casing along a direction angularly offset with respect tothe longitudinal direction L so as to present respective tabs 323 a and323 b that project out the casing 308. Each of the first and secondpusher assemblies 317 a and 317 b can further include first and secondpusher rods 330 a and 330 b, respectively, that extend distally from thecorresponding plungers 316 a and 316 b. When the first and secondplungers 316 a and 316 b are in their respective first positions (FIG.27A), the first and second anchor bodies 28 a and 28 b are disposed inthe respective cannulas 310 a and 310 b. The plungers 316 a and 316 bcan be moved to respective second positions (FIG. 27D) so as to ejectthe respective first and second anchor bodies 28 a and 28 b out therespective cannulas 310 a and 310 b.

The insertion instrument 330 can further include a swap actuator 470that can include a swap tab 470 a that extends out from the casing 308,and can extend out from the body portion 308 a at a location between thefirst and second tabs 323 a and 323 b. The casing 308 can defines slots367 a-c that extend through the upper end of the body portion 308 andare longitudinally elongate, and positioned such that the first andsecond tabs 323 a and 323 b extend out the first and second slots 367 aand 367 b, and the swap tab 470 a extends out the third slot 367 c at alocation between the first and second tabs 323 a and 323 b. The slots367 a-c can thus provide tracks that define the longitudinal movement ofthe first and second pusher assemblies 317 a and 317 b and the swapactuator 470 as the tabs 323 a-b and 470 a ride in the respective slots367 a-c. The swap actuator 470 is configured to be moved from a firstposition to an actuated position so as to reverse a relative position ofthe fist and second tips 311 a and 311 b. For instance, as illustratedin FIG. 27A, the first tip 311 a of the first cannula 310 a is disposeddistally with respect to the second tip 311 b of the second cannula 310b. It should thus be appreciated that the first tip 311 a can beinjected into underlying tissue, for instance at the first targetanatomical location 24 a (see FIG. 1A) without causing the second tip311 b to inject into the underlying tissue. As is described in moredetail below, actuation of the swap actuator 470 from a first position(FIG. 27A) to a second position along the direction of Arrow 355 (FIG.27C) causes the second tip 311 b to move distally with respect to thefirst tip 311 a, such that the second tip 311 b can be injected into theunderlying tissue, for instance at the second target anatomical location24 b (see FIG. 1B) without causing the first tip 311 a to inject intothe underlying tissue.

During operation, referring to FIGS. 27A-B, the first plunger 316 a canbe translated distally along the direction of Arrow 357 from the firstposition to the second position, which causes the first push rod 330 ato likewise translate distally in the first cannula 310 a. The firstpush rod 330 a abuts the first anchor body 28 a, such that the firstpush rod 330 a ejects the first anchor body 28 a out the first cannula310 a, for instance into the first target anatomical location, as thefirst push rod 300 a translates distally to the second position. Thefirst plunger tab 323 a abuts the casing 308 at the distal end of thefirst slot 367 a when the first pusher assembly 317 a is in the secondposition, whereby the first anchor body 28 a has been ejected. Thus,when the first plunger tab 323 a is in the second position, the plunger316 a is prevented from further distal translation. Thus, the user isprovided with tactile feedback that the first anchor body 28 a has beenejected.

Next, referring to FIG. 27C, the swap actuator 470 can be actuated, forinstance can be moved distally along the direction of Arrow 355, fromthe first position to the actuated position, which causes the second tip311 b to advance, or translate distally, with respect to the casing 308and the first cannula 310 a until the second tip 311 b is disposeddistally with respect to the first tip 311 a. It should thus beappreciated that the second tip 311 b can be injected into underlyingtissue, for instance at the second target anatomical location 24 b (seeFIG. 1A) without causing the first tip 311 a to inject into theunderlying tissue. For instance, the distal end of the first push rod330 a, which is disposed distal with respect to the first tip 311 a, canprovide a depth stop for the insertion of the second tip 311 b into thesecond target anatomical location. Thus, the second tip 311 b can beinjected until the first push rod 330 a abuts the anatomical structure.In accordance with the illustrated embodiment, actuation of the swapactuator 470 further causes the second plunger 316 b, and thus thesecond push rod 330 b, to translate distally as illustrated in FIG. 27C.The swap tab 470 a abuts the casing 308 at the distal end of the thirdslot 367 c once the swap actuator 470 has been moved to the actuatedposition, such that the swap actuator 470 is prevented from furtherdistal translation. Thus, the user is provided with tactile feedbackthat the swap actuator 470 has been actuated.

Referring now to FIG. 27D, the second plunger 316 b can be translateddistally along the direction of Arrow 359 from the first position to thesecond position, which causes the second push rod 330 b to likewisetranslate distally in the second cannula 310 b. The second push rod 330b abuts the second anchor body 28 b, such that the second push rod 330 bejects the second anchor body 28 b out the second cannula 330 b, forinstance into the second target anatomical location, as the second pushrod 300 b translates distally to the second position. The second plungertab 323 b abuts the casing 308 at the distal end of the second slot 367b when the second pusher assembly 317 b is in the second position,whereby the second anchor body 28 b has been ejected. Thus, when theplunger tab 323 b is in the second position, the plunger 316 b isprevented from further distal translation. Thus, the user is providedwith tactile feedback that the second anchor body 28 b has been ejected.

Operation of the insertion instrument 300 illustrated in FIGS. 27A-28Bwill now be further described with particular reference to FIGS. 28A-B.In particular, the insertion instrument 300 includes at least one latchassembly such as a first latch assembly 482, a second latch assembly484, and a third latch assembly 486. The first latch assembly 482 isconfigured to lock the swap actuator 470 in its distal position once ithas been moved distally from a first position illustrated in FIG. 27B toa second recessed position illustrated in FIG. 27C. For instance, thefirst latch assembly 482 can include a latch member 488 that issupported by the casing 308 and configured to latch onto the swapactuator 470 so as to be coupled to the swap actuator 470 with respectto translation. The latch member 488 defines a body 488 a, a firstattachment portion 488 b in the form of a hook carried by the body 488a, and a second attachment portion 488 c in the form of an abutmentsurface carried by the body 488 a disposed distal of the firstattachment portion 488 b. As the swap actuator 470 moves distally, thefirst attachment portion 488 a can deflect inwardly away from the swapactuator 470 so as to allow distal translation of the swap member 470relative to the latch member 488, such as an outwardly projecting tab470 a of the swap actuator 470. Once the swap actuator 470 has beenmoved from its first initial position to its second distal positionrelative to the casing 308, the swap actuator 470 contacts the abutmentsurface and the hook can deflect outward under the spring force of thebody 488 a, such that the swap actuator 470, for instance the tab 470 a,becomes captured between the first and second attachment portions 488 band 488 c. Accordingly, the latch member 488 prevents the swap actuator470 from moving proximally and distally relative to the casing once theswap actuator 470 has been moved to its proximal position that advancesthe second pusher assembly 317 b distally with respect to the firstpusher assembly 316 a.

The insertion instrument 300 can further include at least one firstguide member 483 a such as a guide wire that is translatably fixed tothe casing 308. For instance, the insertion instrument 300 can include amount 485 that is supported by the casing 308 and is attached to thefirst guide member 483 a. The first guide member 483 can extend throughthe swap actuator 470 so as to guide the swap actuator to translatedistally.

The second latch assembly 484 is configured to lock the first plunger316 a, and thus the first pusher assembly 317 a, in its proximalposition proximal position once it has been moved distally from a firstposition illustrated in FIG. 27A to a second distal position illustratedin FIG. 27B that causes the first push rod 330 a to eject the firstanchor body 28 a. For instance, the second latch assembly 484 caninclude a latch member 489 that is supported by the casing 308 andconfigured to latch onto the first plunger 316 a so as to be coupled tothe first plunger 316 a with respect to translation. The second latchmember 489 can be constructed substantially identically with respect tothe first latch member 488, and thus defines a body, a first attachmentportion in the form of a hook carried by the body, and a secondattachment portion in the form of an abutment surface carried by thebody and disposed distal of the hook. As the first plunger 316 a movesdistally, the first attachment portion can deflect inwardly away fromthe first plunger 316 a so as to allow distal translation of the firstplunger 316 a relative to the second latch member 489, such as anoutwardly projecting tab 316 c of the first plunger 316 a. Once thefirst plunger 316 a has been moved from its first initial position toits second distal position relative to the casing 308, the first plunger316 a contacts the abutment surface and the hook can deflect outwardunder the spring force of the body of the latch member 489, such thatthe first plunger 316 a, for instance the tab 316 c, becomes capturedbetween the first and second attachment portions of the latch member489. Accordingly, the latch member 489 prevents the first plunger 316 afrom moving proximally and distally relative to the casing 308 once thefirst plunger 316 has been moved to its distal position that ejects thefirst anchor body 28 a from the first cannula 310 a.

The insertion instrument 300 can further include at least one secondguide member 483 b such as a guide wire that is translatably fixed tothe casing 308. For instance, the mount 485 can be attached to thesecond guide member 483 b, which can extend distally through the firstplunger 316 a so as to guide the first plunger 316 a to translatedistally.

The third latch assembly 486 is configured to lock the second plunger316 b, and thus the second pusher assembly 317 b, in its distal positionproximal position once it has been moved distally from a first positionillustrated in FIG. 27C to a second distal position illustrated in FIG.27D that causes the second push rod 330 b to eject the second anchorbody 28 b. For instance, the third latch assembly 486 can include athird latch member 495 that is supported by the casing 308 andconfigured to latch onto the second plunger 316 b so as to be coupled tothe second plunger 316 b with respect to translation. The third latchmember 495 can be constructed substantially identically with respect tothe first and second latch members 488 and 489, and thus defines a body495 a, a first attachment portion 495 b in the form of a hook carried bythe body 495 a, and a second attachment portion 495 c in the form of anabutment surface carried by the body 495 a at a location distal of thehook. As the second plunger 316 b moves distally, the first attachmentportion 495 b can deflect inwardly away from the second plunger 316 b soas to allow proximal translation of the second plunger 316 b relative tothe third latch member 495, such as an outwardly projecting tab 316 d ofthe second plunger 316 b. Once the second plunger 316 b has been movedfrom its first initial position to its second proximal position relativeto the casing 308, the second plunger 316 b, for instance at the tab 316d, contacts the abutment surface 495 c and the hook 495 b can deflectoutward under the spring force of the latch member body 495 a, such thatthe second plunger 316 b becomes captured between the first and secondattachment portions of the latch member 495. Accordingly, the latchmember 495 prevents the second plunger 316 b from moving proximally anddistally relative to the casing 308 once the second plunger 316 b hasbeen moved to its distal position that ejects the second anchor body 28b from the second cannula 310 b.

The insertion instrument 300 can further include at least one thirdguide member 483 c such as a guide wire that is translatably fixed tothe casing 308. For instance, the mount 485 can be attached to the thirdguide member 483 c, which can extend distally through the second plunger316 b so as to guide the second plunger 316 b to translate distally.Furthermore, the insertion instrument 300 can include an attachmentmember 496 in the form of an attachment wire that attaches the secondplunger 316 b to the swap actuator 470 with respect to distaltranslation of the swap actuator 470. For instance, distal translationof the swap actuator 470 causes the second plunger 316 b to translatedistally along with the swap actuator 470. A distal force applied to thesecond plunger 316 b can allow the second plunger 316 b to translatedistally relative to the swap actuator 470. In accordance with oneembodiment, the attachment member 496 can be translatably fixed to theswap actuator 470, and can be attached to the second plunger 316 b sothat it interferes with the second plunger 316 with respect to proximalmovement 316 b of the second plunger 316 b relative to the attachmentmember 493. The swap actuator 470 can include a second tab 470 b that isattached to the second cannula 310 b with respect to translation, suchthat distal translation of the swap actuator 470 causes the secondcannula 310 b to translate distally along with the swap actuator 470.Accordingly, distal translation of the swap actuator 470 causes theattachment member 496 to drag the second plunger 316 b, the secondcannula 310 b, and the second push rod 330 b distally until the secondtip 311 b is disposed distal of the first tip 311 a. Because the firstpusher rod 330 a remains disposed distal of the first tip 311 a afterthe first anchor body 28 a has been ejected, the distal end of the firstpusher rod 330 a can define an insertion depth stop for the second tip311 b in the manner described above.

The attachment member 496 can extend at least partially through thesecond plunger 496 b so as to allow the second plunger 496 b totranslate distally with respect to the attachment member 496 andtherefore also with respect to the swap actuator 470. As a result, oncethe swap actuator 470 has been translated distally, thereby alsotranslating the second cannula 310 b and the second pusher assembly 317b distally, translation of the second plunger 316 b causes the secondpush rod 330 b to eject the second anchor body 28 b from the secondcannula 310 b in the manner described above.

Referring now to FIGS. 29A-29G generally, the insertion instrument 300can be configured having a first and second cannulas 310 a and 310 bsupported by the casing 308 in a side-by-side orientation that retainfirst and second anchor bodies 28 a and 28 b, and first and secondpusher assemblies 317 a and 317 b operatively associated with the firstand second cannulas 310 a and 310 b, respectively, so as to eject thefirst and second anchor bodies 28 a and 28 b out the respective firstand second cannulas 310 a and 310 b. Furthermore, as described above, itcan be desirable to ensure that a desired cannula from which the anchorbody is to be ejected is distally disposed with respect to the othercannula, such that the desired cannula can be inserted into theunderlying tissue without also inserting the other cannula.

As illustrated in FIG. 29A, the insertion instrument 300 includes acasing 308 that includes a first casing portion 308 a and a secondcasing portion 308 b that is disposed adjacent the first casing portion308 b. The insertion instrument 300 further includes a first cannula 310a that extends distally from the first casing portion 308 a, and asecond cannula 310 b that extends distally from the second casingportion 308 b. The first and second casing portions 308 a and 308 b canextend substantially parallel to each other as illustrated. Accordingly,the first and second cannulas 310 a and 310 b can be described as beingin a side-by-side relationship. The first and second cannulas 310 a and310 b can define respective longitudinally elongate channels that retainrespective first and second anchor bodies 28 a and 28 b in the mannerdescribed above. The first and second cannulas 310 a and 310 b canfurther include longitudinally elongate side slots 337 a and 337 b,respectively, that extend into one side of the cannulas and are incommunication with the respective elongate channels. Accordingly, theattachment portions 133 a-b of the actuation strands 38 a and 38 b canextend out the respective side slots 337 a and 337 b and attach to eachother (see FIG. 1A) when the first and second anchor bodies 28 a and 28b are loaded in the respective first and second cannulas 310 a and 310b.

The insertion instrument 300 can further include first and second pusherassemblies 317 a and 317 b operatively associated with the first andsecond cannulas 310 a and 310 b, respectively. Thus, the first pusherassembly 317 a is configured to eject the first anchor body 28 a out thefirst cannula 310 a, and the second pusher assembly 317 b is configuredto eject the second anchor body 28 b out the second cannula 310 b. Thefirst and second cannulas 310 a and 310 b can define respective firstand second tapered tips 311 a and 311 b, and first and second distalejection ports that extend longitudinally through the respective tips311 a and 311 b.

Each of the first and second pusher assemblies 317 a and 317 b includesfirst and second plungers 316 a and 316 b, respectively, that aredisposed outside the respective first and second casing portions 308 aand 308 b at a location proximal with respect to the casing portions 308a and 308 b as illustrated. Each of the first and second pusherassemblies 317 a and 317 b can further include first and second pusherrods 330 a and 330 b, respectively, that extend distally from thecorresponding plungers 316 a and 316 b, through the respective first andsecond casing portions 308 a and 308 b, and into the respective firstand second cannulas 310 a and 310 b. When the first and second plungers316 a and 316 b are in their respective first positions (FIG. 29A), thefirst and second anchor bodies 28 a and 28 b are disposed in therespective cannulas 310 a and 310 b. The plungers 316 a and 316 b can bemoved to respective second positions (FIG. 29F) so as to eject therespective first and second anchor bodies 28 a and 28 b out therespective cannulas 310 a and 310 b.

The insertion instrument 330 can further include a swap actuator 470that can include a swap button 470 a that extends laterally through thefirst casing portion 308 a and into the second casing portion 308 b. Theswap actuator 470 is configured to selectively couple and decouple thefirst and second casing portions with respect to relative translation inthe longitudinal direction L. For instance, as illustrated in FIGS. 29Band 29G, the first and second casing portions 308 a and 308 b can beslidably coupled along the longitudinal direction. For instance, one ofthe casing portions, such as the first casing portion 308 a, can definea slot 375 extending along at least a portion of its longitudinallength. The other casing portion, such as the second casing portion 308b, can include a slider member such as a projection 377 that isconfigured to ride inside the slot so as to guide longitudinal movementof the first and second casing portions 308 a and 308 b relative to eachother. The slot 375 and the projection 377 can flare angularly outwardin a dovetail arrangement such that the first and second casing portions308 a and 308 b are prevented from separating along a directionangularly offset from the longitudinal direction L. The swap actuator470 is configured to move the first and second casing portions 308 a and308 b relative to each other along the longitudinal direction such thatthe respective tips 311 a and 311 b move from a first relative positionto a second relative position that is opposite the first relativeposition.

For instance, as illustrated in FIG. 29A, the first tip 311 a of thefirst cannula 310 a can be initially disposed distally with respect tothe second tip 311 b of the second cannula 310 b. It should thus beappreciated that the first tip 311 a can be injected into underlyingtissue, for instance at the first target anatomical location 24 a (seeFIG. 1A) without causing the second tip 311 b to inject into theunderlying tissue. As is described in more detail below, actuation ofthe swap actuator 470 from a first position (FIG. 29D) to a secondposition causes the second tip 311 b to move distally with respect tothe first tip 311 a such that the second tip 311 b is positioned distalof the first tip 311 a. Accordingly, the second tip 311 b can beinjected into the underlying tissue, for instance at the second targetanatomical location 24 b (see FIG. 1B) without causing the first tip 311a to inject into the underlying tissue.

During operation, referring to FIG. 29C, the first plunger 316 a can betranslated distally from the first position to the second position,which causes the first push rod 330 a to likewise translate distally inthe first cannula 310 a. The first push rod 330 a abuts the first anchorbody 28 a, such that the first push rod 330 a ejects the first anchorbody 28 a out the first cannula 310 a, for instance into the firsttarget anatomical location, as the first push rod 300 a translatesdistally to the second position. The first plunger 316 a can abuts thefirst casing portion 308 a when the first pusher assembly 317 a is inthe second position, whereby the first anchor body 28 a has beenejected. Thus, when the first plunger 316 a is in the second position,the first plunger 316 a is prevented from further distal translation.Thus, the user is provided with tactile feedback that the first anchorbody 28 a has been ejected.

Next, referring to FIGS. 29C, 29D, and 29G, the swap actuator 470 can beactuated so as to reverse the relative position of the first and secondtips 311 a and 311 b in the manner described above. For instance, theswap actuator 470 can include a button 472 that extends laterallythrough the first casing portion 308 a and into the second casingportion 308 a. The second casing portion 308 b can include a springmember 474 that biases the button 472 outward toward its first position.The button 472 can include at least one flange 476 that abuts a wall ofthe second casing portion 308 b so as to prevent the force of the springmember 474 from ejecting the button 472 out the first casing portion 308a.

The first casing portion 308 a can include a pair of apertures 478 a-bsized to receive the button 472 such that the button 472 extends out thefirst casing portion 308 a. The first aperture 478 a is disposedproximal with respect to the second aperture 478 b. When the button 472extends through the first aperture 478 a, the first tip 311 a isdisposed distal with respect to the second tip 311 b. Furthermore,interference between the button 472 and the first casing portion 308 aprevents the first casing portion 308 a from translating longitudinallyrelative to the second casing portion 308 b. When the button 472 isdepressed into the slot 375, and thus into the projection 377,interference between the button 472 and the first casing portion 308 ais removed, such that the first and second casing portions 308 a and 308b are configured to translate longitudinally relative to each other. Forinstance, the second casing portion 308 b, and thus the second cannula310 b, can slide distally with respect to the first casing portion 308a, and thus the first cannula 310 a, until the button 472 is driventhrough the second aperture 478 b as illustrated in FIG. 29D. When thebutton 472 extends through the second aperture 478 b, the second tip 311b is disposed distal with respect to the first tip 311 a. It should thusbe appreciated that the second tip 311 b can be injected into underlyingtissue, for instance at the second target anatomical location 24 b (seeFIG. 1A) without causing the first tip 311 a to inject into theunderlying tissue.

Referring now to FIGS. 29D-E, the insertion instrument 300 can furtherinclude a lock-out tab 468 that is removably attached to the second pushrod 330 b at a location longitudinally between the corresponding plunger316 b and the second casing portion 308 b. Accordingly, the lock-out tab468 interferes with the distal translation of the plunger 316 b relativeto the second casing portion 308 b to a depth that would eject therespective second anchor body 28 b. The lock-out tab 468 can remainattached to the second push rod 330 b until the first anchor body 28 ahas been ejected and the swap actuator 470 has been actuated. Theinsertion instrument 300 can further include a lock-out tab operativelyassociated with the first pusher assembly 317 in the manner describedwith respect to the second pusher assembly 317 b.

Referring now to FIGS. 29E-F, once the lock-out tab 468 has been removedfrom the second push rod 430, the second plunger 316 b can be translateddistally from the first position to the second position, which causesthe second push rod 330 b to likewise translate distally in the secondcannula 310 b. The second push rod 330 b abuts the second anchor body 28b, such that the second push rod 330 b ejects the second anchor body 28b out the second cannula 330 b, for instance into the second targetanatomical location, as the second push rod 300 b translates distally tothe second position. The grip portion 432 b of the second plunger 416 babuts the casing 308 at the distal end after the second anchor body 28 bhas been ejected, thereby providing the user with tactile feedback thatthe second anchor body 28 b has been ejected.

Referring now to FIGS. 30A-D generally, the insertion instrument 300 canbe configured having a first and second cannulas 310 a and 310 bsupported by the casing 308 in a side-by-side orientation that retainfirst and second anchor bodies, respectively. Each of the first andsecond cannulas 310 a and 310 b is supported by the casing 308 so as tobe translatably movable with respect to the casing 308. The insertioninstrument 300 further includes a reciprocal motion assembly 500 that isconfigured to drive the first and second cannulas 310 a and 310 b inopposite directions. For instance, when the first cannula 310 a isdriven distally with respect to the casing 308, the reciprocal motionassembly 500 drives the second cannula 310 b proximally with respect tothe casing 308. Similarly, when the first cannula 310 a is drivenproximally with respect to the casing 308, the reciprocal motionassembly 500 drives the second cannula 310 b distally with respect tothe casing 308. Similarly, when the second cannula 310 b is drivendistally with respect to the casing 308, the reciprocal motion assembly500 drives the first cannula 310 a proximally with respect to the casing308. Similarly, when the second cannula 310 b is driven proximally withrespect to the casing 308, the reciprocal motion assembly 500 drives thefirst cannula 310 a distally with respect to the casing 308.

The insertion instrument 300 can include a pusher assembly 317 having aplunger 316 and first and second pusher members 330 a and 330 b. Thefirst pusher member 330 a extends into the first cannula 330 a and isconfigured to eject a first anchor body out the first cannula 330 a inthe manner described above. Similarly, the second pusher member 330 bextends into the second cannula 330 b and is configured to eject asecond anchor body 28 b out the second cannula 330 b in the mannerdescribed above. The insertion instrument further can include aselective plunger engagement assembly 502 that is operable so as toselectively engage the plunger between one of the first and second pushrods 330 a and 330 b. Thus, the plunger 316 can be translatably coupledto the first push rod 330 a, such that distal translation of the plunger316 causes the push rod 330 a to translate distally and eject the firstanchor body 28 a out of the respective first cannula 330 a. The plunger316 can be translatably coupled to the second push rod 330 b, such thatdistal translation of the plunger 316 causes the push rod 330 b totranslate distally and eject the second anchor body 28 b out of therespective first cannula 330 b.

Referring now to FIGS. 30A-C, the reciprocal motion assembly 500includes a first force transfer member, such as a toothed first rack 504a that is attached to the first cannula 310 a and is translatably fixedto the first cannula 310 a. The first rack 504 a can be integral withthe first cannula 310 a or discretely attached to the first cannula 310a as desired. In accordance with the illustrated embodiment, the firstrack 504 a extends proximally from the first cannula 310 a. Thereciprocal motion assembly 500 can further include a second forcetransfer member such as a second toothed rack 504 b that is attached tothe second cannula 310 b and is translatably fixed to the second cannula310 b. The second rack 504 b can be integral with the second cannula 310b or discretely attached to the second cannula 310 b as desired. Inaccordance with the illustrated embodiment, the second rack 504 bextends proximally from the second cannula 310 b.

The reciprocal motion assembly 500 can further include a third forcetransfer member such as a first gear 506 a, which can be a spur gear,that mates with the first rack such that rotation of the first gear 506a drives the first rack 504 a to translate substantially linearly, forinstance proximally or distally. The first cannula 310 a translatesalong with the first rack 504 a. The reciprocal motion assembly 500 canfurther include a fourth force transfer member such as a second gear 506b, which can be a spur gear, that mates with the second rack 504 b suchthat rotation of the second gear 506 b drives the first rack 504 a totranslate substantially linearly, for instance proximally or distally.The second cannula 310 b translates along with the second rack 504 b.Furthermore, the first and second gears 506 a and 506 b are mated suchthat rotation of one of the first and second gears 506 a and 506 b in afirst rotational direction along their respective axes of rotation 508 aand 508 b drives the other of the first and second gears 506 a and 506 bto rotate in a second rotational direction opposite the first rotationaldirection. The first and second gears 506 a and 506 b can be supportedin the casing 308 such that the axes of rotation 508 a and 508 b remainsstationary as the gears 506 a and 506 b rotate.

The second rack 504 b can include a handle 508 b that extends out thecasing 308. During operation, for instance when the first cannula 310 aextends distal with respect to the second cannula 310 b, the handle 508b can be driven distally, which causes the second cannula 310 b and thesecond rack 504 b to translate distally, thereby rotating the secondgear 506 b along a direction of rotation. The second gear 506 b drivesthe first gear 506 a to rotate along an opposite direction of rotation,which causes the first cannula 310 a to translate proximally toward thecasing 308. Thus, as the second cannula 310 b is driven distally, thereciprocal motion assembly drives the first cannula 310 in an oppositedirection, such as proximally as illustrated.

When the second cannula 310 b extends distal with respect to the firstcannula 310 a, the handle 508 b can be driven proximally, which causesthe second cannula 310 b and the second rack 504 b to translateproximally, thereby rotating the second gear 506 b along a direction ofrotation. The second gear 506 b drives the first gear 506 a to rotatealong an opposite direction of rotation, which causes the first cannula310 a to translate distally away from the casing 308. Thus, as thesecond cannula 310 b is driven proximally, the reciprocal motionassembly drives the first cannula 310 a in an opposite direction, suchas distally as illustrated.

The handle 508 b can include a hook 510 that latches onto the casing 308so as to provide a safety catch that prevents distal translation of thehandle 508, and thus also distal translation of the second rack 504 b.The hook 510 can be configured to latch onto the casing 308 when thesecond cannula 310 b is retracted, and the first cannula 310 a isextended and disposed distal with respect to the second cannula 310 b.

Referring now to FIGS. 30C-D, the selective plunger engagement assembly502 includes a track 512 carried by the casing 308. The track 512 canextend radially outward into an inner wall of the casing 308. The trackincludes a first portion 512 a that extends substantially longitudinallyand parallel to the cannulas 310 a and 310 b and the push rods 330 a and330 b. The track further includes a second portion 512 b that extendsfrom the first portion 512 a, for instance from the proximal end of thefirst portion 512 a, and extends proximally and outward, such aslaterally outward, from the first portion 512 b. Thus, it can be saidthat the second portion 512 b is offset with respect to the firstportion 512 a. In accordance with the illustrated embodiment, the secondportion 512 b is angularly offset with respect to the first portion 512a.

The plunger 316 is configured to ride in the track 512, and is movabledistally along the track 512 so as to drive a select one of the firstand second push rods 330 a and 330 b distally within a respective one ofthe first and second cannulas 310 a and 310 b so as to eject therespective one of the first and second anchors out the insertioninstrument. In accordance with the illustrated embodiment, the first andsecond push rods 330 a and 330 b carry first and second engagementmembers 514 a and 514 b. The engagement members 514 a and 514 b can bespaced from each other so as to provide clearance as the first andsecond cannulas 310 a and 310 b are driven reciprocally. It should beappreciated that because the first and second push rods 330 a and 330 bextend into the respective first and second cannulas 310 a and 310 b,the push rods 330 a and 330 b are likewise driven reciprocally duringreciprocal movement of the cannulas 310 a and 310 b.

The plunger 316 carries a biasing member 516 that is longitudinallyaligned with each of the engagement members 514 a and 514 b when theplunger 316 is disposed in the first track portion 512 a. The plunger316 further carries a follower 518 that is sized and shaped so as toride in the track 512 and guide the travel path of the plunger 316 asthe plunger is driven proximally and distally. The plunger 316 caninclude a proximal end that extends out, for instance proximally out,from the casing 308. Thus, the plunger 316 can be driven distally alongthe first track portion 512 a and proximally along the first trackportion 512 a. The plunger can further be driven proximally along thesecond track portion 512 b, which causes the biasing member 516 to moveout of longitudinal alignment with the engagement members 514 a and 514b. Thus, the cannulas 310 a and 310 b, and the respective push rods 330a and 330 b, can move reciprocally without the engagement members 514 aand 514 b interfering with each other, and further without theengagement members 514 a and 514 b interfering with the biasing member516 of the plunger 316.

When it is desired to eject one of the anchor bodies out of therespective cannula, for instance the first cannula 310 a, the first pushrod 330 a can be placed into alignment with the plunger 316. Forinstance, the reciprocal motion assembly 500 can be actuated as desiredso as to position the respective engagement member 514 a distal of theproximal end of the first track portion 512 a. Accordingly, the plunger316 can be driven distally along the track 512. Once the plunger 512travels distally along the first track portion 512 a, the biasing member516 engages the engagement member 514 a, and drives the push rod 330 adistally in the respective cannula 310 a, thereby ejecting the anchorbody out the cannula 310 a as described above.

Once it is desired to eject the second anchor body from the secondcannula 310 b, the plunger 316 can be driven proximally onto the secondtrack portion 512 b until the biasing member 516 is out of longitudinalalignment with the engagement members 514 a and 514 b of the first andsecond push rods 330 a and 330 b. Next, the reciprocal motion assembly500 can be actuated so as to drive the second cannula 310 b and secondpush rod 330 b distally, which causes the first cannula 310 a and thefirst push rod 330 a to translate proximally, until the first engagementmember 514 a is disposed proximal of the proximal end of the first trackportion 512 a, and the second engagement member 514 b is disposed distalof the proximal end of the first track portion 512 a. Thus, the secondcannula 310 b is disposed distal with respect to the first cannula 310a. Next, the plunger 316 can be driven distally, which causes thebiasing member 516 to engage the second engagement member 514 b, whichdrives the second push rod 330 b distally in the second cannula 330 b soas to eject the second anchor out the insertion instrument.

Referring now to FIG. 31, while various insertion instruments 300 havebeen described as including a distal ejection port 442, the insertioninstruments 300 can define a side ejection port 318 as an alternative tothe distal ejection port 442. For instance, the side ejection port 318can be defined as a slot that extends radially through a distal portionof the cannula 310 at a location proximal with respect to the tip 311.The tip 311 can be closed so as to prevent the anchor bodies 28 a and 28b from ejecting out the distal ejection port 442 that is defined by thetip 311. The side ejection port 318 can define a circumferentialdimension at least substantially equal to or greater than the largestcross-sectional dimension of each of the first and second anchor bodies28 a and 28 b, such that the anchor bodies 28 a and 28 b are sized totravel through the side ejection port 318. Furthermore, the sideejection port 318 can define a longitudinal length that is substantiallyequal to or greater than the longitudinal length of each of the firstand second anchor bodies 28 a and 28 b. The longitudinal length of theside ejection port 318 can be slightly less than that of each of thefirst and second anchor bodies 28 a and 28 b, for instance, if the firstand second anchor bodies 28 a and 28 b are angularly offset with respectto the longitudinal axis 302 as they are ejected out the side ejectionport 318.

The tip 311 can define a ramp 372 at its proximal end. The ramp 372 canthus be disposed at the distal end of the side ejection port 318 andsubstantially aligned with the longitudinal axis 302. The ramp 372 candefine a tapered ejection surface 374 that is angled radially outwardtoward the side ejection port 318 as it extends distally. Accordingly,as the plug 314 biases the second anchor body 28 b distally from theelongate opening 312 of the cannula 310 onto the ejection surface 374 asthe plunger 316 and push tube 334 collar 332 move from the firstposition to the second position, second anchor body 28 b rides along theejection surface 374, which directs the second anchor body 28 b out theside ejection port 318 along the direction of Arrow B, thereby ejectingthe second anchor body 28 b out the insertion instrument 300 at thesecond target anatomical location 24 b (see FIG. 1A). When the at leastthe distal portion of the side ejection port 318 is disposed behind theanatomical structure 24, the second anchor body 28 b is ejected from theinsertion instrument 300 at a location behind the anatomical structure24, as further shown in FIG. 1A. The insertion instrument 300 can beconfigured such that the plug 314 is disposed proximal to and adjacentto the tip 311 when the push rod 330 and the push tube 334 becomedecoupled. Accordingly, translation of the push rod 330 relative to thepush tube 334 causes the push rod to eject the first anchor 28 a alongthe ramp surface 378 of the plug 314 in the manner described above, andout the side ejection port 318.

The embodiments described in connection with the illustrated embodimentshave been presented by way of illustration, and the present invention istherefore not intended to be limited to the disclosed embodiments.Furthermore, the various structures, features, and methodologiesassociated with any embodiment described herein can apply to any otherembodiment as described herein, unless otherwise indicated. Forinstance, unless otherwise indicated, any insertion instrument describedherein can include a retention assembly as described herein inaccordance with any suitable alternative embodiment, a cutting assemblyas described herein or in accordance with any suitable alternativelyembodiment, a swap assembly of the type described herein or constructedin accordance with any suitable alternative embodiment, a reciprocalmotion assembly of the type described herein or constructed inaccordance with any suitable alternative embodiment, and a selectiveplunger engagement assembly of the type described herein or constructedin accordance with any suitable alternative embodiment. Accordingly,those skilled in the art will realize that the invention is intended toencompass all modifications and alternative arrangements included withinthe spirit and scope of the invention, for instance as set forth by theappended claims.

1. An insertion instrument configured to eject at least one anchor at atarget location, the anchor including an anchor body that has asubstrate that extends substantially along a direction of elongation,the substrate defining a plurality of openings spaced along thedirection of elongation, the anchor further including an actuationmember that is woven through at least two of the openings, the insertioninstrument comprising: a cannula defining an elongate opening sized toreceive the anchor body; and a pusher member insertable into the cannulaand configured to be depressed in the elongate opening so as to ejectthe anchor body from the cannula and into the target location, such thatwhen a tensile force is applied to the actuation member along adirection substantially along the direction of elongation, the anchorbody expands along a second direction perpendicular with respect to thedirection of elongation.
 2. The insertion instrument as recited in claim1, wherein the pusher member is configured to brace against the anchorbody.
 3. The insertion instrument according to claim 1, wherein thecannula defines a slot that receives the actuation member, such that theactuation member extends from the knot body out the cannula.
 4. Theinsertion instrument according to claim 1, wherein the pusher membercomprises a push rod that has an outer cross-sectional dimension whichis smaller than that of the elongate opening of said cannula such thatthe actuation member extends through said elongate opening of saidcannula alongside the push rod.
 5. The insertion instrument according toclaim 1, wherein the pusher member comprises a central bore so that theanchor body can be inserted through the central bore and into theelongate opening of the cannula.
 6. The insertion instrument accordingto claim 1, wherein the insertion instrument further comprises a handle,and the cannula is removably attached to the handle.
 7. The insertioninstrument according to claim 1, wherein said cannula has a conicalinlet.
 8. The insertion instrument according to claim 1, whereindepressing the pusher member causes the anchor body to translate out theopening.
 9. The insertion instrument according to claim 8, wherein thecannula defines a distal end that defines a needle tip, and depressingthe pusher member causes the anchor body to translate distally out theopening.
 10. The insertion instrument according to claim 9, wherein theneedle tip is conical.
 11. The insertion instrument according to claim8, wherein the opening terminates at a distal end, and the cannuladefines a side ejection portal in communication with the distal end ofthe opening.
 12. The insertion instrument according to claim 11, furthercomprising a tip that extends distally from the cannula.
 13. Theinsertion instrument according to claim 12, wherein the tip is conical.14. The insertion instrument according to claim 13, wherein the tipcomprises a cone.
 15. The insertion instrument according to claim 8,wherein the cannula defines a tapered distal end.
 16. The insertioninstrument according to claim 1, wherein the cannula defines a firstlongitudinal aperture and the pusher member defines a secondlongitudinal aperture so that by rotating said pusher member relative tosaid cannula said first and second aperture can be aligned and saidinsertion instrument can be released from said anchor body.
 17. Theinsertion instrument according to claim 1, wherein the pusher member isa first pusher member, the insertion instrument further comprising acannulated second pusher member disposed in the elongate opening of thecannula.
 18. The insertion instrument according to claim 17, wherein thefirst pusher member is disposed in the cannulated second pusher member.19. The insertion instrument according to claim 18, wherein thecannulated second pusher member contains a first anchor body.
 20. Theinsertion instrument according to claim 19, wherein the cannula furthercontains a second anchor body disposed distal to the first anchor body.21. The insertion instrument according to claim 20, wherein the firstpusher member is initially coupled to the second pusher member such thatthe first pusher member and the second pusher member translate distallyin tandem during a first stroke.
 22. The insertion instrument accordingto claim 21, wherein the first stroke causes the second pusher member toeject the second anchor body out the cannula.
 23. The insertioninstrument according to claim 22, wherein the first pusher member isdecoupled from the second pusher member after the first stroke.
 24. Theinsertion instrument according to claim 23, wherein a second stroke ofthe first pusher member ejects the first anchor body from the cannula.25. The insertion instrument according to claim 24, wherein the firstand second pusher members are coupled so as to translate in tandemduring a first portion of the second stroke.
 26. The insertioninstrument according to claim 20, further comprising a casing that istranslatably fixed to the cannula.
 27. The insertion instrumentaccording to claim 26, further comprising complementary first and secondguide members that are operably coupled between the casing and thesecond pusher member so as to guide relative movement between the casingand the second pusher member.
 28. The insertion instrument according toclaim 27, further comprising an attachment member that is translatablyfixed to the second pusher member.
 29. The insertion instrumentaccording to claim 28, further comprising a plunger translatably fixedto the first pusher member.
 30. The insertion instrument according toclaim 29, wherein the first and second guide members are operablycoupled between the casing and the attachment member.
 31. The insertioninstrument according to claim 29, wherein the first and second guidemembers are configured to translatably couple the first pusher member tothe second pusher member.
 32. The insertion instrument according toclaim 29, wherein the attachment member is translatably coupled to theplunger.
 33. The insertion instrument according to claim 31, wherein theattachment member comprises a collar that extends about the plunger. 34.The insertion instrument according to claim 28, wherein the first andsecond guide members comprise a 1) guide track that extends into atleast one of the attachment member and the casing, and 2) a guide pinthat is coupled to the other of the attachment member and the casing,such that the guide pin rides in the guide track.
 35. The insertioninstrument according to claim 34, wherein the guide track extends intothe attachment member and the guide pin extends from the casing into theguide track.
 36. The insertion instrument according to claim 35, whereinthe guide pin is translatably fixed to the casing.
 37. The insertioninstrument according to claim 35, wherein the guide track defines afirst track portion and a second track portion that is offset withrespect to the first track portion.
 38. The insertion instrument asrecited in claim 37, wherein rotation of the plunger causes the guidepin to ride from the first track portion to the second track portion.39. The insertion instrument as recited in claim 38, wherein theattachment member defines a stop member at terminal ends of the firstand second track portions.
 40. The insertion instrument as recited inclaim 34, wherein the guide pin translates proximally in the guide trackas the plunger moves distally relative to the casing so as to eject thefirst and second anchor bodies from the insertion instrument.
 41. Theinsertion instrument as recited in claim 34, wherein the guide trackdefines a base having an edge, wherein the guide pin translates alongthe edge so as to provide at least one of tactile and audio feedback.42. The insertion instrument according to claim 1, further comprising acasing that is translatably fixed to the cannula.
 43. The insertioninstrument according to claim 42, further comprising complementary firstand second guide members that are operably coupled between the casingand the pusher member so as to guide relative movement between thecasing and the first pusher member.
 44. The insertion instrumentaccording to claim 42, wherein the cannula further contains a secondanchor body disposed distal to the first anchor body.
 45. The insertioninstrument as recited in claim 44, wherein the cannula defines a distalejection port, and the first and second anchor bodies are ejected outthe distal ejection port along a direction substantially parallel to theelongate opening.
 46. The insertion instrument according to claim 44,wherein the first guide member a guide track, and the second guidemember is a guide pin that rides in the guide track as the plunger movesdistally relative to the casing so as to eject the first and secondanchor bodies from the insertion instrument.
 47. The insertioninstrument according to claim 44, wherein the guide track is carried bythe casing.
 48. The insertion instrument according to claim 47, whereinthe guide pin is translatably fixed to the first pusher member.
 49. Theinsertion instrument according to claim 48, wherein the guide trackdefines a first track portion and an intermediate track portion thatextends out from the first track portion
 50. The insertion instrument asrecited in claim 49, wherein rotation of the plunger causes the guidepin to ride from the first track portion to the intermediate trackportion.
 51. The insertion instrument as recited in claim 49, furthercomprising a guide housing that defines at least one aperture extendingtherethrough, and the plunger carries at least one guide post that isradially offset from the at least one aperture before the plunger isrotated, and is aligned with the at least one aperture after the plungeris rotated.
 52. The insertion instrument as recited in claim 51, whereinthe guide post extends through the at least one aperture as the plungerfurther translates along a second stroke so as to eject the first andsecond anchor bodies from the cannula.
 53. The insertion instrumentaccording to claim 20, further comprising a coupling assembly configuredto releasably translatably fix the first and second pusher members. 54.The insertion instrument according to claim 53, wherein the couplingassembly fixes the first and second pusher members during a first strokewhereby the second anchor body is ejected from the cannula.
 55. Theinsertion instrument according to claim 54, wherein the couplingassembly decouples the first and second pusher members from each otherduring a second stroke such that the first pusher member is translatablerelative to the second pusher member, whereby the first pusher memberejects the first anchor body out the cannula.
 56. The insertioninstrument according to claim 53, further comprising an attachmentmember that is translatably fixed to the second pusher member.
 57. Theinsertion instrument according to claim 56, further comprising a plungertranslatably fixed to the first pusher member.
 58. The insertioninstrument according to claim 57, wherein the attachment member isreleasably attached to the plunger with respect to translation.
 59. Theinsertion instrument according to claim 58, wherein the couplingassembly comprises a coupling member that is carried by the attachmentmember, and is configured to further extend into a first recess of theplunger so as to translatably couple the attachment member to theplunger.
 60. The insertion instrument according to claim 59, furthercomprising a casing that is translatably fixed to the cannula.
 61. Theinsertion instrument according to claim 60, wherein the casing carries asecond recess that is spaced from the first recess.
 62. The insertioninstrument according to claim 61, wherein the casing defines the secondrecess.
 63. The insertion instrument according to claim 62, wherein whenthe coupling member moves to a location aligned with the second recess,the coupling member is driven out of the first recess and into thesecond recess, thereby translatably decoupling the attachment member andthe plunger.
 64. The insertion instrument according to claim 63, whereinthe attachment member defines a channel, and the coupling member isconfigured to move across the channel so as to decouple from the plungerand couple to the casing
 65. The insertion instrument as recited inclaim 61, wherein the casing carries an inner housing that carries thesecond recess.
 66. The insertion instrument as recited in claim 65,wherein when the coupling member moves to a location aligned with thesecond recess, the coupling member is driven out of the first recess andinto the second recess, thereby translatably decoupling the attachmentmember and the plunger.
 67. The insertion instrument as recited in claim66, wherein the coupling member comprises a leaf spring that is attachedto the attachment member.
 68. The insertion instrument as recited inclaim 66, wherein the leaf spring is integral with the attachmentmember.
 69. The insertion instrument according to claim 61, furthercomprising complementary first and second guide members that areoperably coupled between the casing and the second pusher member so asto guide relative movement between the casing and the second pushermember.
 70. The insertion instrument according to claim 69, wherein thecomplimentary guide members define a first portion, a second portionthat is offset from the first portion, and stop at one end of the firstportion.
 71. The insertion instrument according to claim 70, wherein thecoupling member is a latch, and a stop of the first portion preventsdistal translation of the second pusher member before the latch isaligned with the second recess.
 72. The insertion instrument accordingto claim 71, wherein the first portion has a length sufficient such thatmovement of the guide member along the first portion causes the secondpusher member to eject the second anchor body from the insertioninstrument.
 73. The insertion instrument according to claim 72, whereinmovement of the guide member along the second portion causes the latchto move in alignment with the second recess.
 74. The insertioninstrument according to claim 73, wherein the latch moves into thesecond recess so as to translatably decouple the first and second pushermembers, such that the first pusher member is translatable independentlyof the second pusher member so as to eject the first anchor body fromthe instrument.
 75. The insertion instrument as recited in claim 74,wherein the cannula defines a distal ejection port, and the first andsecond anchor bodies are ejected from the instrument through the distalejection port.
 76. The insertion instrument as recited in claim 73,wherein the second pusher member comprises a plug that is disposed suchthat an ejection port of the cannula extends between the plug and thefirst pusher member when the latch is in alignment with the secondrecess, such that the first anchor body can be ejected from theinstrument through the ejection port.
 77. The insertion instrument asrecited in claim 73, wherein further translation of the first pushermember is independent of the second pusher member so as to eject thefirst anchor body from the instrument.
 78. The insertion instrumentaccording to claim 1, further comprising a depth stop that extends outfrom the cannula.
 79. The insertion instrument according to claim 1,further configured to retain at least one end of a tensioning memberthat is coupled to the actuation member.
 80. The insertion instrumentaccording to claim 79, wherein the tensioning member comprises atensioning strand having first and second ends, and the insertioninstrument is configured to retain the first and second ends.
 81. Theinsertion instrument accordingly to claim 80, configured to selectivelyrelease one of the first and second ends.
 82. The insertion instrumentaccordingly to claim 81, further comprising a retention assembly that ismovable with the pusher member, and proximal movement of the insertioninstrument after the anchor body has been ejected causes the tensileforce to be applied to the actuation member.
 83. The insertioninstrument according to claim 81, wherein the insertion instrument isfurther configured to eject a second anchor at a second target location,the second anchor including a second anchor body that has a secondsubstrate that extends substantially along a second direction ofelongation, the second substrate defining a plurality of openings spacedalong the second direction of elongation, the second anchor furtherincluding a second actuation member that is woven through at least twoof the openings of the second anchor body, such that the tensioningstrand is configured to apply a tensile force to the second anchor bodyso as to expand the second anchor body along a direction perpendicularwith respect to the second direction of elongation.
 84. The insertioninstrument accordingly to claim 83, wherein the at least one anchor is afirst anchor, the anchor body is a first anchor body, the substrate is afirst substrate, the plurality of openings is a first plurality ofopenings, the direction of elongation is a first direction ofelongation, the actuation member is a first actuation member, thetensile force is a first tensile force, and the retention assembly ismovable with the pusher member, such that proximal movement of thepusher member after the first anchor body has been ejected causes thefirst tensile force to be applied to the first actuation member, and thepusher member is configured to be depressed in the elongate opening soas to eject the anchor body from the cannula, such that when a secondtensile force is applied to the second actuation member, the secondanchor body expands, wherein the retention assembly is movable with thepusher member, such that proximal movement of the pusher member afterthe second anchor body has been ejected causes the second tensile forceto be applied to the second actuation member.
 85. The insertioninstrument as recited in claim 81, further comprising a tapered surfacethat defines a tapered bore, and a first locking member having across-sectional dimension less than a first end of the tapered bore andgreater than a second end of the tapered bore, wherein the first lockingmember is configured to releasably retain at least one of the first andsecond ends of the tensioning strand between the locking member and thetapered surface.
 86. The insertion instrument according to claim 85,further comprising a second locking member that is configured to attachto a second end of the tensioning strand.
 87. The insertion instrumentaccording to claim 85, wherein the second locking member is threadedlyattached at a location adjacent the tapered inner surface.
 88. Theinsertion instrument according to claim 87, wherein the second lockingmember is aligned with the tapered bore, such that the second end of thetensioning strand extends through the tapered bore and is attached tothe second locking member.
 89. The insertion instrument according toclaim 86, further comprising a plunger translatably fixed to the firstpusher member, wherein the plunger is configured to depress the firstpusher member in the elongate opening.
 90. The insertion instrumentaccording to claim 89, further comprising a release member incommunication with the first locking member, wherein movement of therelease member biases the first locking member out to release thetensioning strand.
 91. The insertion instrument according to claim 90,wherein the release member pushes the first locking member toward thefirst end of the bore so as to create a gap between the first lockingmember and the tapered inner surface.
 92. The insertion instrumentaccording to claim 81, further comprising a retention assembly includinga first locking body configured to releasably retain the first end ofthe tensioning strand, and a second locking body configured to retainthe second end of the tensioning assembly.
 93. The insertion instrumentaccording to claim 92, further comprising an actuator operably coupledto the first locking body so as to release the first locking body fromthe first end of the tensioning strand.
 94. The insertion instrumentaccording to claim 92, further configured to eject a second anchor bodyout the cannula, wherein the actuator becomes operably coupled to thefirst locking body once the first and second anchor bodies have beenejected.
 95. The insertion instrument according to claim 81, furthercomprising a cutting assembly having a cutting blade, the cuttingassembly movable between a disengaged position whereby the cutting bladeis spaced from the tensioning strand and an engaged position whereby thecutting blade severs the tensioning strand.
 96. The insertion instrumentaccording to claim 95, wherein the cutting assembly includes alongitudinally elongate shaft that is coupled to the cutting blade, andlongitudinal translation of the shaft causes the blade to sever thetensioning strand.
 97. The insertion instrument according to claim 96,wherein the cutting assembly further includes a switch pivotally coupledbetween both the elongate shaft and the cutting blade.
 98. The insertioninstrument according to claim 95, wherein the cutting assembly includesan actuator that is elongate along a direction angularly offset withrespect to the cannula, and movement along the direction angularlyoffset with respect to the cannula severs the tensioning strand.
 99. Theinsertion instrument according to claim 1, further comprising aretention assembly comprising a first locking member and a secondlocking member adjacent the first locking member so as to define astrand-receiving gap therebetween, wherein the second locking member ismovable toward the first locking member so as to retain at least onestrand in the gap.
 100. The insertion instrument according to claim 99,wherein the cannula defines a slot in communication with the elongateopening, and the at least one strand extends from the at least one knotanchor out the slot and into the gap.
 101. The insertion instrument asrecited in claim 99, wherein the second locking member is threadedlycoupled to the first locking member.
 102. The insertion instrumentaccording to claim 24, further comprising a stop member that istranslatably fixed with respect to the cannula, and a clip removablycouples the first and second pusher members.
 103. The insertioninstrument according to claim 102, further comprising a plunger that istranslatably fixed to the first pusher member, the plunger configured tobe depressed so as to depress the first pusher member in the elongateopening.
 104. The insertion instrument according to claim 102, whereinthe clip is removably attached to the plunger.
 105. The insertioninstrument according to claim 104, further comprising an attachmentmember that is translatably fixed to the second pusher member, whereinthe clip abuts the attachment member.
 106. The insertion instrumentaccording to claim 105, further comprising a casing that is translatablyfixed to the cannula.
 107. The insertion instrument according to claim106, wherein the plunger is depressed a first distance that causes theanchor body to be ejected from the instrument, and the clip abuts thecasing once the plunger has been depressed the first distance so as toprevent the plunger from being depressed a second distance greater thanthe first distance.
 108. The insertion instrument according to claim107, wherein removal of the clip from the plunger translatably decouplesthe first and second pusher members, such that depression of the plungerthe second distance causes the first pusher member to eject anotheranchor body from the insertion instrument.
 109. The insertion instrumentas recited in claim 1, wherein the anchor is a first anchor, thesubstrate is a first substrate, the direction of elongation is a firstdirection of elongation, the actuation member is a first actuationmember that is woven through at least two of the openings, the cannulais a first cannula, the elongate opening is a first elongate opening,and the pusher member is a first pusher member, the insertion instrumentfurther comprising: a second cannula that defines a second elongateopening sized to receive a second anchor body that has a secondsubstrate that extends substantially along a second direction ofelongation, the second substrate defining a plurality of openings spacedalong the second direction of elongation, the second anchor furtherincluding a second actuation member that is woven through at least twoof the openings of the second anchor body; and a second pusher memberinsertable into the second cannula and configured to be depressed in thesecond elongate opening so as to eject the second anchor body from thesecond cannula and into a second target location, such that when atensile force is applied to the second actuation member along adirection substantially along the second direction of elongation, thesecond anchor body expands along a second direction perpendicular withrespect to the direction of elongation.
 110. The insertion instrument asrecited in claim 109, further wherein the first and second cannulasextend substantially parallel to each other.
 111. The insertioninstrument as recited in claim 109, further comprising a casing thatsupports the first and second cannulas such that the first and secondcannulas extend distally to respective first and second tips, whereinthe first tip is disposed distal to the second tip when the first anchorbody is ejected, and the insertion instrument further comprises a swapactuator that is configured to position second tip is disposed distal tothe first tip after the first anchor body is ejected and before thesecond anchor body is ejected.
 112. The insertion instrument as recitedin claim 111, further comprising a first plunger extending out from thefirst push member and a second plunger extending out from the secondpush member, and first and second pair of lock-out tabs removablyattached to the first and second plungers, respectively, at a locationbetween the casing and proximal ends of the respective first and secondplungers, wherein the lock-out tabs prevent the first and secondplungers from moving the respective first and second push a distancesufficient to eject the respective first and second anchor bodies. 113.The insertion instrument as recited in claim 112, wherein removal of thefirst and second lock-out tabs from the first and second plungers allowsthe first and second plungers to translate, thereby causing therespective first and second pusher members to eject the respective firstand second anchor bodies from the corresponding first and secondcannulas.
 114. The insertion instrument as recited in claim 111, whereinthe swap actuator is configured to translate the first tip proximallywith respect to the second tip after the first anchor body has beenejected from the first cannula.
 115. The insertion instrument as recitedin claim 114, wherein the casing comprises a body portion that supportsand a handle portion that extends out from the body portion, the firstand second cannulas extend out from the body portion, and the swapactuator extends out from the handle portion.
 116. The insertioninstrument as recited in claim 114, further comprising at least onelatch assembly that couples the swap actuator to the first cannula withrespect to proximal translation, such that proximal translation of theswap actuator causes the first cannula to translate proximally withrespect to the second cannula.
 117. The insertion instrument as recitedin claim 111, further comprising a first plunger extending out from thefirst push member and a second plunger extending out from the secondpush member, the first and second plungers disposed in respective firstand second slots that extend through the casing.
 118. The insertioninstrument as recited in claim 111, wherein the swap actuator isconfigured to translate the second tip distally with respect to thesecond tip after the first anchor body has been ejected from the firstcannula.
 119. The insertion instrument as recited in claim 118, whereinthe swap actuator is further configured to translate the second tipdistally with respect to the casing.
 120. The insertion instrument asrecited in claim 119, wherein the swap actuator further comprises a swaptab that rides in a slot defined by the casing.
 121. The insertioninstrument as recited in claim 118, further comprising at least onelatch assembly that attaches the swap actuator to the second cannulawith respect to distal translation, such that distal translation of theswap actuator causes the second cannula to advance distally with respectto the first cannula.
 122. The insertion instrument as recited in claim111, wherein the casing comprises a first casing portion and a secondcasing portion, the first cannula extends from the first casing portion,and the second cannula extends from the second casing portion.
 123. Theinsertion instrument as recited in claim 111, wherein the first andsecond casing portions are configured to slide relative to each other.124. The instrument assembly as recited in claim 123, wherein the swapactuator selectively couples and decouples the first and second casingportions with respect to relative translation.
 125. The instrumentassembly as recited in claim 124, wherein movement of the swap actuatorfrom a first position to a second position allows the second casingportion to slide distally with respect to the first casing portion suchthat the second tip is disposed distal with respect to the first tip.126. The instrument assembly as recited in claim 125, wherein the swapactuator comprises a button that is spring loaded in the second casingportion.
 127. The insertion instrument as recited in claim 111, furthercomprising a reciprocal motion assembly that causes one of the first andsecond cannulas to translate proximally when the other of the first andsecond cannulas translates distally.
 128. The insertion instrument asrecited in claim 127, wherein the reciprocal motion assembly includes afirst rack coupled the first cannula, and further includes a second rackcoupled to the second cannula, a first gear mated with the first rack,and a second gear mated with the second rack, such that the first andsecond gears are mated with each other.
 129. The insertion instrument asrecited in claim 128, further comprising a handle extending from one ofthe racks and out the casing.
 130. The insertion instrument as recitedin claim 129, wherein the handle defines a safety catch configured toengage the casing so as to prevent movement of the handle along at leastone direction when the handle is engaged with the casing.
 131. Theinsertion instrument as recited in claim 128, further comprising aplunger configured to selectively engage one of the first and secondpusher members.
 132. The insertion instrument as recited in claim 131,wherein the plunger carries a biasing member and is movable from a firstposition whereby the biasing member is aligned with the first and secondpusher members to a second position whereby the biasing member is out ofalignment with the first and second pusher members.
 133. The insertioninstrument as recited in claim 132, wherein the plunger rides in a trackhaving a first portion that extends along a direction substantiallyparallel to the first and second pusher members, such that the plungeris movable distally along the track so as to drive a select one of thefirst and second pusher members distally within a respective one of thefirst and second cannulas so as to eject the respective one of the firstand second anchors.
 134. The insertion instrument as recited in claim133, wherein the track has a second offset portion, wherein translationof the plunger into the second offset portion causes the biasing memberto become misaligned with the first and second pusher rods.
 135. Theinsertion instrument as recited in claim 134, wherein a relativeposition of the first and second cannulas can be reversed when theplunger is disposed in the second offset portion of the track.